We found a strong correlation between travel volumes departing from Wuhan, Hubei Province before the Spring Festival and the extent of amplification of the outbreak of COVID-19 in China in 2020, with 100 top cities. Almost 70% of exportations were within cities in Hubei province.

Background: Mounting experimental evidence supports the concept that the RAAS (renin-angiotensin-aldosterone system) is involved in the pathogenesis of intracranial aneurysm rupture. However, whether RAAS inhibitors could reduce the rupture risk of intracranial aneurysms remains unclear. Methods: We performed a chart review of a multicenter, prospectively maintained database of 3044 hypertensive patients with intracranial aneurysms from 20 medical centers in China. The patients were separated into ruptured and unruptured groups. Univariable and multivariable logistical regression analyses were performed to determine the association between the use of RAAS inhibitors and the rupture risk. Sensitivity analyses and subgroup analyses were performed to verify the robustness of the results. Results: In multivariable analyses, female sex, passive smoking, uncontrolled, or unmonitored hypertension, use of over 2 antihypertensive medications, RAAS inhibitors use, antihyperglycemic agents use, hyperlipidemia, ischemic stroke, and aneurysmal location were independently associated with the rupture risk. The use of RAAS inhibitors was significantly associated with a reduced rupture risk compared with the use of non-RAAS inhibitors (odds ratio, 0.490 [95% CI, 0.402–0.597]; P =0.000). Compared with the use of non-RAAS inhibitors, the use of ACE (angiotensin-converting enzyme) inhibitors (odds ratio, 0.559 [95% CI, 0.442–0.709]; P =0.000) and use of ARBs (angiotensin receptor blockers; odds ratio, 0.414 [95% CI, 0.315–0.542]; P =0.000) were both significantly associated with a reduced rupture risk. The negative association of the rupture risk with RAAS inhibitors was consistent across 3 analyzed data and the predefined subgroups (including controlled hypertension). Conclusions: The use of RAAS inhibitors was significantly associated with a decreased rupture risk independent of blood pressure control among hypertensive patients with intracranial aneurysms.

Background: Socioeconomic factors play an indispensable role in the spread of emerging infectious diseases. Few studies have investigated the role of socioeconomic factors in the spread of COVID-19. Methods: The number of COVID-19 cases in the 39 well-developed cities of China was aggregated by searching the publicly available sources. Socioeconomic indicators (e.g., population, population density, gross domestic product, rural-to-urban migrants, urbanization rate, per-person disposable income, and level of health care) in these cities were also aggregated from the Bureau of Statistics. The data referring to travelers from Wuhan were collected from the Baidu Migration database. A multiple stepwise linear regression model was performed to identify the independent risk factors of the number of cases. Results: As of Mar 19, 2020, a total of 5,939 cases were reported in the 39 well-developed cities with almost half of total cases in China outside of Hubei. The number of cases ranged 20–576, and the median number of cases was 93 (IQR 54–180) in these cities. Nine socioeconomic variables including the number of travelers from Wuhan, population, native population, gross domestic product, Per-person GDP, the number of hospitals, the number of rural-to-urban migrants, traffic capacity, and person-disposable income were recognized as potential contributors of the number of cases. Results of multiple linear regression showed a statistically significant association between the number of cases and the number of travelers from Wuhan (t = 6.746, P = 0.000) and the number of rural-to-urban migrants (t = 3.776, P = 0.001) in these cities. However, other seven potential contributors were not associated with the number of cases. Moreover, a well-fitted multiple regression model was built in this study, and a regression equation was as follows: Y = 0.007X_t + 0.200X_m (adjusted R² = 0.833). Conclusions: Travelers from Wuhan and rural-to-urban migrants were independently associated with the COVID-19 outbreak in the 39 well-developed cities of China. These findings suggested that travelers from an epicenter and rural-to-urban migrants should be paid more attention in the early stage of the COVID-19 outbreak in the well-developed cities.