Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States of America.
Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States of America.
PLoS One. 2020 Dec 9;15(12):e0241956. doi: 10.1371/journal.pone.0241956. eCollection 2020.
Healthcare workers face distinct occupational challenges that affect their personal health, especially during a pandemic. In this study we compare the characteristics and outcomes of Covid-19 patients who are and who are not healthcare workers (HCW).
We retrospectively analyzed a cohort of 2,842 adult patients with known HCW status and a positive SARS-CoV-2 RT-PCR test presenting to a large academic medical center emergency department (ED) in New York State from March 21 2020 through June 2020. Early in the pandemic we instituted a policy to collect data on patient occupation and exposures to suspected Covid-19. The primary outcome was hospital admission. Secondary outcomes were ICU admission, need for invasive mechanical ventilation (IMV), and mortality. We compared baseline characteristics and outcomes of Covid-19 adult patients based on whether they were or were not HCW using univariable and multivariable analyses.
Of 2,842 adult patients (mean age 53+/-19 years, 53% male) 193 (6.8%) were HCWs and 2,649 (93.2%) were not HCWs. Compared with non-HCW, HCWs were younger (43 vs 53 years, P<0.001), more likely female (118/193 [61%] vs 1211/2649 [46%], P<0.001), and more likely to have a known Covid-19 exposure (161/193 [83%] vs 946/2649 [36%], P<0.001), but had fewer comorbidities. On presentation to the ED, HCW also had lower frequencies of tachypnea (12/193 [6%] vs 426/2649 [16%], P<0.01), hypoxemia (15/193 [8%] vs 564/2649 [21%], P<0.01), bilateral opacities on imaging (38/193 [20%] vs 1189/2649 [45%], P<0.001), and lymphocytopenia (6/193 [3%] vs 532/2649 [20%], P<0.01) compared to non-HCWs. Direct discharges home from the ED were more frequent in HCW 154/193 (80%) vs 1275/2649 (48%) p<0.001). Hospital admissions (38/193 [20%] vs 1264/2694 [47%], P<0.001), ICU admissions (7/193 [3%] vs 321/2694 [12%], P<0.001), need for IMV (6/193 [3%] vs 321/2694 [12%], P<0.001) and mortality (2/193 [1%] vs 219/2694 [8%], P<0.01) were lower than among non-HCW. After controlling for age, sex, comorbidities, presenting vital signs and radiographic imaging, HCW were less likely to be admitted (OR 0.6, 95%CI 0.3-0.9) than non HCW.
Compared with non HCW, HCW with Covid-19 were younger, had less severe illness, and were less likely to be admitted.
医护人员面临独特的职业挑战，这会影响他们的个人健康，尤其是在大流行期间。本研究旨在比较患有 COVID-19 的医护人员（HCW）和非医护人员（非 HCW）的特征和结局。
我们回顾性分析了来自纽约州一家大型学术医疗中心急诊部的 2842 名已知 HCW 身份和 SARS-CoV-2 RT-PCR 检测阳性的成年患者队列。在大流行早期，我们制定了一项政策，收集患者职业和疑似 COVID-19 暴露的相关数据。主要结局是住院。次要结局包括 ICU 入院、需要有创机械通气（IMV）和死亡率。我们使用单变量和多变量分析比较了基于是否为 HCW 的 COVID-19 成年患者的基线特征和结局。
在 2842 名成年患者中（平均年龄 53+/-19 岁，53%为男性），193 人为 HCW（6.8%），2649 人为非 HCW（93.2%）。与非 HCW 相比，HCW 更年轻（43 岁 vs 53 岁，P<0.001），更可能为女性（118/193 [61%] vs 1211/2649 [46%]，P<0.001），且更有可能有已知的 COVID-19 暴露史（161/193 [83%] vs 946/2649 [36%]，P<0.001），但合并症较少。在急诊就诊时，HCW 的呼吸急促频率（12/193 [6%] vs 426/2649 [16%]，P<0.01）、低氧血症（15/193 [8%] vs 564/2649 [21%]，P<0.01）、影像学双侧混浊（38/193 [20%] vs 1189/2649 [45%]，P<0.001）和淋巴细胞减少症（6/193 [3%] vs 532/2649 [20%]，P<0.01）的频率也较低。与非 HCW 相比，HCW 更频繁地直接从急诊室出院（154/193 [80%] vs 1275/2649 [48%]，P<0.001）。住院（38/193 [20%] vs 1264/2694 [47%]，P<0.001）、ICU 入院（7/193 [3%] vs 321/2694 [12%]，P<0.001）、需要 IMV（6/193 [3%] vs 321/2694 [12%]，P<0.001）和死亡率（2/193 [1%] vs 219/2694 [8%]，P<0.01）均低于非 HCW。在校正年龄、性别、合并症、就诊时生命体征和影像学表现后，HCW 入院的可能性低于非 HCW（OR 0.6，95%CI 0.3-0.9）。
与非 HCW 相比，患有 COVID-19 的 HCW 更年轻，病情较轻，住院的可能性较小。
