美国在新冠疫情期间的脑血管病死亡率过高。
Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic.
机构信息
Department of Neurology, Division of Vascular Neurology, Yale School of Medicine, New Haven, CT (R.S., LR.K., L.H.S., A.J.).
Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit (D.M.W.), Yale School of Public Health, New Haven, CT.
出版信息
Stroke. 2021 Jan;52(2):563-572. doi: 10.1161/STROKEAHA.120.031975. Epub 2021 Jan 12.
BACKGROUND AND PURPOSE
The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19-related vascular pathology.
METHODS
United States and state-level excess cerebrovascular deaths from January to May 2020 were quantified using National Center for Health Statistic data and Poisson regression models. Excess cerebrovascular deaths were analyzed as a function of time-varying stroke-related emergency medical service (EMS) calls and cumulative COVID-19 deaths using linear regression. A state-level regression analysis was performed to determine the association between excess cerebrovascular deaths and time spent in residences, measured by Google Community Mobility Reports, during the height of the pandemic after the first COVID-19 death (February 29).
RESULTS
Forty states and New York City were included. Excess cerebrovascular mortality occurred nationally from the weeks ending March 28 to May 2, 2020, up to a 7.8% increase above expected levels during the week of April 18. Decreased stroke-related EMS calls were associated with excess stroke deaths one (70 deaths per 1000 fewer EMS calls [95% CI, 20-118]) and 2 weeks (85 deaths per 1000 fewer EMS calls [95% CI, 37-133]) later. Twenty-three states and New York City experienced excess cerebrovascular mortality during the pandemic height. A 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths (incidence rate ratio, 1.043 [95% CI, 1.001-1.085]) after adjusting for COVID-19 deaths.
CONCLUSIONS
Excess US cerebrovascular deaths during the COVID-19 pandemic were observed and associated with decreases in stroke-related EMS calls nationally and mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.
背景与目的
目前尚不清楚 2019 年冠状病毒病（COVID-19）大流行期间脑血管疾病死亡率过高的程度和驱动因素。我们旨在量化与中风相关的超额死亡人数，并描述其与社会隔离行为和 COVID-19 相关血管病理学的关系。
方法
利用国家卫生统计中心的数据和泊松回归模型，量化 2020 年 1 月至 5 月期间美国各州的超额脑血管死亡人数。采用线性回归分析，根据时间变化的中风相关紧急医疗服务（EMS）调用和 COVID-19 死亡人数的累积情况，分析超额脑血管死亡人数。对各州的回归分析用于确定在 COVID-19 首例死亡（2 月 29 日）后大流行高峰期，通过谷歌社区流动性报告（Google Community Mobility Reports）衡量的居住地时间与超额脑血管死亡人数之间的关系。
结果
纳入了 40 个州和纽约市。2020 年 3 月 28 日至 5 月 2 日这一周，全美出现了超额脑血管死亡率，与 4 月 18 日这一周相比，高出了 7.8%。中风相关 EMS 调用减少与中风死亡人数增加呈正相关，一个（每减少 1000 次 EMS 调用，死亡人数增加 70 人[95%CI，20-118]）和两个（每减少 1000 次 EMS 调用，死亡人数增加 85 人[95%CI，37-133]）星期后。23 个州和纽约市在大流行高峰期经历了超额脑血管死亡率。调整 COVID-19 死亡人数后，在家时间增加 10%，中风死亡人数增加 4.3%（发病率比，1.043[95%CI，1.001-1.085]）。
结论
美国 COVID-19 大流行期间观察到脑血管死亡人数过多，并与全国范围内与中风相关的 EMS 调用减少以及各州的流动性减少有关。需要采取公共卫生措施，以确定并应对 COVID-19 大流行期间急性中风就医意愿降低的问题。
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