Examining the Economic Value of Investing in Health

This review article examines the relationship between health and economic development,highlighting the economic benefits of investing in health.The rise of non-communicable diseases(NCDs)and the COVID-19 pandemic have exposed high demand for increased investment in health as well as critical gaps in the global health system,particularly in low-and middle-income countries,where investments in primary healthcare and innovations in health technologies are lacking.The article emphasizes the importance of examining the economic impact of health,providing a summary of the different pathways through which health impacts the economy and reviewing various economic analyses,including a novel methodology called the health-augmented macroeconomic model(HMM)for evaluating the macroeconomic value of investing in health.The article suggests that reducing disease burdens can effectively generate sizable economic returns,and it is vital to integrate the concept of economic value in health policies and interventions.

Factors Predicting Progression to Severe COVID-19: A Competing Risk Survival Analysis of 1753 Patients in Community Isolation in Wuhan, China

Most studies of coronavirus disease 2019(COVID-19)progression have focused on the transfer of patients within secondary or tertiary care hospitals from regular wards to intensive care units.Little is known about the risk factors predicting the progression to severe COVID-19 among patients in community iso-lation,who are either asymptomatic or suffer from only mild to moderate symptoms.Using a multivari-able competing risk survival analysis,we identify several important predictors of progression to severe COVID-19—rather than to recovery—among patients in the largest community isolation center in Wuhan,China from 6 February 2020(when the center opened)to 9 March 2020(when it closed).All patients in community isolation in Wuhan were either asymptomatic or suffered from mild to moderate COVID-19 symptoms.We performed competing risk survival analysis on time-to-event data from a cohort study of all COVID-19 patients(n=1753)in the isolation center.The potential predictors we inves-tigated were the routine patient data collected upon admission to the isolation center:age,sex,respira-tory symptoms,gastrointestinal symptoms,general symptoms,and computed tomography(CT)scan signs.The main outcomes were time to severe COVID-19 or recovery.The factors predicting progression to severe COVID-19 were:male sex(hazard ratio(HR)=1.29,95%confidence interval(CI)1.04–1.58,p=0.018),young and old age,dyspnea(HR=1.58,95%CI 1.24–2.01,p<0.001),and CT signs of ground-glass opacity(HR=1.39,95%CI 1.04–1.86,p=0.024)and infiltrating shadows(HR=1.84,95%CI 1.22–2.78,p=0.004).The risk of progression was found to be lower among patients with nausea or vomiting(HR=0.53,95%CI 0.30–0.96,p=0.036)and headaches(HR=0.54,95%CI 0.29–0.99,p=0.046).Our results suggest that several factors that can be easily measured even in resource-poor set-tings(dyspnea,sex,and age)can be used to identify mild COVID-19 patients who are at increased risk of disease progression.Looking for CT signs of ground-glass opacity and infiltrating shadows may be an affordable option to support triage decisions in resource-rich settings.Common and unspecific symptoms(headaches,nausea,and vomiting)are likely to have led to the identification and subsequent community isolation of COVID-19 patients who were relatively unlikely to deteriorate.Future public health and clinical guidelines should build on this evidence to improve the screening,triage,and monitoring of COVID-19 patients who are asymtomatic or suffer from mild to moderate symptoms.

Correlation between rate-pressure product or pressure-rate quotient and urinary albumin-creatinine ratio in the Chinese older population:The REACTION study

To the Editor:Chronic kidney disease(CKD)is a critical health threat.An elevated urinary albumin-creatinine ratio(UACR)is a marker of impaired renal function and is a key risk factor for cardiovascular disease.The rate-pressure product(RPP)[1]and pressure rate quotient(PRQ)are widely used as methods to quantify cardiac load and hemodynamic response to exercise in clinical practice.Therefore,to better predict CKD,it is of great signicance to explore the relationships between RPP or PRQ and UACR.