Dartmouth College, Hanover, USA.
National Bureau for Economic Research, Cambridge, USA.
Eur J Epidemiol. 2020 Dec;35(12):1123-1138. doi: 10.1007/s10654-020-00698-1. Epub 2020 Dec 8.
Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.
确定 COVID-19 的特定年龄感染病死率，为保护脆弱年龄组的公共卫生政策和沟通提供信息。通过在线搜索已发表的文章、预印本和政府报告，对 COVID-19 的流行情况进行了研究，这些研究报告在 2020 年 9 月 18 日之前公开发布。系统评价共纳入了 113 项研究，其中 27 项研究（涵盖 34 个地理位置）符合纳入标准，并纳入了荟萃分析。使用流行数据和研究期间中点后 4 周报告的死亡人数计算特定年龄的 IFR，反映了死亡和报告的典型滞后。Stata 中的元回归程序用于分析年龄与感染病死率（IFR）之间的关系。我们的分析发现，COVID-19 的年龄和 IFR 之间呈指数关系。对于儿童和年轻成年人，特定年龄的 IFR 非常低（例如，10 岁时为 0.002%，25 岁时为 0.01%），但逐渐增加到 55 岁时为 0.4%，65 岁时为 1.4%，75 岁时为 4.6%，85 岁时为 15%。此外，我们的结果表明，地理区域之间人口 IFR 的变化约 90%反映了人口年龄结构的差异，以及相对脆弱年龄组接触病毒的程度。这些结果表明，COVID-19 不仅对老年人而且对中年成年人都有危险，对于后者，感染病死率比每年发生致命车祸的风险高出两个数量级，比季节性流感危险得多。此外，COVID-19 的总体 IFR 不应被视为一个固定参数，而应与特定年龄的感染模式密切相关。因此，减轻老年人感染的公共卫生措施可以大大减少总死亡人数。
