Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain.
Unitat de Suport a la recerca Camp de Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Catalunya, Spain.
BMJ Open. 2020 Dec 10;10(12):e041577. doi: 10.1136/bmjopen-2020-041577.
To investigate possible relationships between pre-existing medical conditions (including common comorbidities and chronic medications) and risk for suffering COVID-19 disease in middle-aged and older adults.
Population-based retrospective cohort study.
Twelve primary care centres (PCCs) in Tarragona (Spain).
79 083 people (77 676 community-dwelling and 1407 nursing-home residents), who were all individuals aged >50 years affiliated to the 12 participating PCCs.
Baseline cohort characteristics (age, sex, vaccinations, comorbidities and chronic medications) were established at study start (1st. March 2020) and primary outcome was time to COVID-19 confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to 23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating multivariable HRs adjusted for age, sex, comorbidities and medications use.
During the study period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, which means an incidence of 480.5 PCR-confirmed COVID-19 cases per 100 000 persons-period. Assessing the total study cohort, only age (HR 1.02; 95% CI 1.01 to 1.03; p=0.002), nursing-home residence (HR 21.83; 95% CI 16.66 to 28.61; p<0.001) and receiving diuretics (HR 1.35; 95% CI 1.04 to 1.76; p=0.026) appeared independently associated with increased risk. Smoking (HR 0.62; 95% CI 0.41 to 0.93; p=0.022), ACE inhibitors (HR 0.68; 95% CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95% CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among community-dwelling individuals, cancer (HR 1.52; 95% CI 1.03 to 2.24; p=0.035), chronic respiratory disease (HR 1.82; 95% CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95% CI 1.06 to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE inhibitors (HR 0.66; 95% CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; 95% CI 0.44 to 0.91; p=0.012) was associated with decreased risk.
Age, nursing-home residence and multiple comorbidities appear predisposing for COVID-19. Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be protective, which should be closely investigated in further studies specifically focused on these concerns.
调查中老年人群中先前存在的医疗状况（包括常见合并症和慢性药物治疗）与 COVID-19 患病风险之间的可能关系。
基于人群的回顾性队列研究。
塔拉戈纳（西班牙）的 12 个初级保健中心（PCC）。
79083 人（77676 名社区居住者和 1407 名养老院居民），均为参加 12 个参与 PCC 的年龄>50 岁的个体。
在研究开始时（2020 年 3 月 1 日）确定了基线队列特征（年龄、性别、疫苗接种、合并症和慢性药物治疗），主要结局是在整个流行期间（2020 年 3 月 1 日至 2020 年 5 月 23 日）队列成员中通过 PCR 确诊 COVID-19 的时间。使用 Cox 回归评估 COVID-19 患病风险，估计多变量 HRs 并调整年龄、性别、合并症和药物使用。
在研究期间，对 2324 名队列成员进行了 PCR 检测，其中 1944 名结果为阴性，380 名结果为阳性，这意味着每 100000 人中有 480.5 例经 PCR 确诊的 COVID-19 病例。评估整个研究队列，只有年龄（HR 1.02；95%CI 1.01 至 1.03；p=0.002）、养老院居住（HR 21.83；95%CI 16.66 至 28.61；p<0.001）和使用利尿剂（HR 1.35；95%CI 1.04 至 1.76；p=0.026）与增加的风险独立相关。吸烟（HR 0.62；95%CI 0.41 至 0.93；p=0.022）、ACE 抑制剂（HR 0.68；95%CI 0.47 至 0.99；p=0.046）和抗组胺药（HR 0.47；95%CI 0.22 至 1.01；p=0.052）与较低的风险相关。在社区居住者中，癌症（HR 1.52；95%CI 1.03 至 2.24；p=0.035）、慢性呼吸道疾病（HR 1.82；95%CI 1.08 至 3.07；p=0.025）和心脏病（HR 1.53；95%CI 1.06 至 2.19；p=0.021）也与增加的风险相关。使用 ACE 抑制剂（HR 0.66；95%CI 0.44 至 0.99；p=0.046）和流感疫苗接种（HR 0.63；95%CI 0.44 至 0.91；p=0.012）与降低的风险相关。
年龄、养老院居住和多种合并症似乎使 COVID-19 易感性增加。相反，使用 ACE 抑制剂、抗组胺药和流感疫苗接种可能具有保护作用，这在专门针对这些问题的进一步研究中应密切关注。
