In this cross-sectional study of 540,667 adult hospitalized patients with COVID-19, 94.9% had at least 1 underlying medical condition. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, anxiety disorders, and the total number of conditions were the strongest risk factors for severe COVID-19 illness. What are the implications for public health practice?Preventing COVID-19 in populations with these underlying conditions and multiple conditions should remain a public health priority, with targeted mitigation efforts and ensuring high uptake of vaccine, when available, in these individuals and their close contacts.

Background Older adults and people from certain racial and ethnic groups are disproportionately represented in coronavirus disease 2019 (COVID-19) hospitalizations and deaths. Methods Using data from the Premier Healthcare Database on 181 813 hospitalized adults diagnosed with COVID-19 during March–September 2020, we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death) and to determine whether the impact of age on clinical severity differs by race/ethnicity. Results Overall, 84 497 (47%) patients were admitted to the ICU, 29 078 (16%) received IMV, and 27 864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio, 0.96; 95% CI, 0.92–0.99) and higher among Hispanic/Latino patients (risk ratio [RR], 1.15; 95% CI, 1.09–1.20), non-Hispanic Asian patients (RR, 1.16; 95% CI, 1.09–1.23), and patients of other racial and ethnic groups (RR, 1.13; 95% CI, 1.06–1.21). Risk of ICU admission and risk of IMV were elevated among some racial and ethnic groups. Conclusions These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce severe acute respiratory syndrome coronavirus 2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.

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Holoprosencephaly (HPE) is a major structural birth defect of the brain that occurs in approximately 1 in 10,000 live births. Although some genetic causes of HPE are known, a substantial proportion of cases have an unknown etiology. Due to the low birth prevalence and rarity of exposure to many potential risk factors for HPE, few epidemiologic studies have had sufficient sample size to examine risk factors. A 2010 review of the literature identified several risk factors that had been consistently identified as occurring more frequently among cases of HPE, including maternal diabetes, twinning, and a predominance of females, while also identifying a number of potential risk factors that had been less widely studied. In this article, we summarize a systematic literature review conducted to update the evidence for nongenetic risk factors for HPE.

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Objective: To estimate the annual percentage of women of reproductive age with private insurance or Medicaid who had opioid prescription claims during 2013-2017 and describe trends over time.Design: A secondary analysis of insurance claims data from IBM MarketScan® Commercial and Multi-State Medicaid Databases to assess outpatient pharmacy claims for prescription opioids among women aged 15-44 years during 2013-2017.Participants: Annual cohorts of 3.5-3.8 million women aged 15-44 years with private insurance and 0.9-2.1 million women enrolled in Medicaid.Main Outcome Measure: The percentage of women aged 15-44 years with outpatient pharmacy claims for opioid prescriptions.Results: During 2013-2017, the proportion of women aged 15-44 years with private insurance who had claims for opioid prescriptions decreased by 22.1 percent, and among women enrolled in Medicaid, the proportion decreased by 31.5 percent.Conclusions: Opioid prescription claims decreased from 2013 to 2017 among insured women of reproductive age. However, opioid prescription claims remained common and were more common among women enrolled in Medicaid than those with private insurance; additional strategies to improve awareness of the risks associated with opioid prescribing may be needed.

Background Some studies have reported associations between prenatal use of venlafaxine, a serotonin‐norepinephrine reuptake inhibitor used for depressive and anxiety disorders, and some birth defects. We described the prevalence of venlafaxine prescription claims among privately insured women of reproductive age and pregnant women. Methods Venlafaxine prescription claims were examined using the IBM MarketScan Commercial Databases. We included women of reproductive age (15–44 years) who had ≤45 days of lapsed enrollment during the calendar year of interest (2011–2016) in a non‐capitated healthcare plan sponsored by a large, self‐insured employer with prescription drug coverage and no mental health service carve‐out. Annual cohorts of pregnant women were identified among eligible women of reproductive age via pregnancy diagnosis and procedure codes. Venlafaxine prescriptions were identified via National Drug Codes in outpatient pharmacy claims and we estimated the annual proportion of women with venlafaxine claims by pregnancy trimester (pregnant women only), age, and Census division. Results Each year during 2011–2016, approximately 1.2% of eligible reproductive‐aged and 0.3% of eligible pregnant women filled a venlafaxine prescription. Among pregnant women, the proportion with venlafaxine claims was highest during the first trimester and decreased during the second and third trimesters. Small temporal increases in venlafaxine claims were observed for reproductive‐aged and pregnant women, with the largest among women aged 15–19 years. Conclusions Venlafaxine prescription claims were low among women of reproductive age and pregnant women during 2011–2016, with some increasing use over time among women aged 15–19 years.