Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2021 Jan 4;4(1):e2035699. doi: 10.1001/jamanetworkopen.2020.35699.
Although health care workers (HCWs) are at higher risk of acquiring coronavirus disease 2019 (COVID-19), it is unclear whether they are at risk of poorer outcomes.
To evaluate the association between HCW status and outcomes among patients hospitalized with COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, observational cohort study included consecutive adult patients hospitalized with a diagnosis of laboratory-confirmed COVID-19 across 36 North American centers from April 15 to June 5, 2020. Data were collected from 1992 patients. Data were analyzed from September 10 to October 1, 2020.
Data on patient baseline characteristics, comorbidities, presenting symptoms, treatments, and outcomes were collected, including HCW status.
The primary outcome was a requirement for mechanical ventilation or death. Multivariable logistic regression was performed to yield adjusted odds ratios (AORs) and 95% CIs for the association between HCW status and COVID-19-related outcomes in a 3:1 propensity score-matched cohort, adjusting for residual confounding after matching.
In total, 1790 patients were included, comprising 127 HCWs and 1663 non-HCWs. After 3:1 propensity score matching, 122 HCWs were matched to 366 non-HCWs. Women comprised 71 (58.2%) of matched HCWs and 214 (58.5%) of matched non-HCWs. Matched HCWs had a mean (SD) age of 52 (13) years, whereas matched non-HCWs had a mean (SD) age of 57 (17) years. In the matched cohort, the odds of the primary outcome, mechanical ventilation or death, were not significantly different for HCWs compared with non-HCWs (AOR, 0.60; 95% CI, 0.34-1.04). The HCWs were less likely to require admission to an intensive care unit (AOR, 0.56; 95% CI, 0.34-0.92) and were also less likely to require an admission of 7 days or longer (AOR, 0.53; 95% CI, 0.34-0.83). There were no differences between matched HCWs and non-HCWs in terms of mechanical ventilation (AOR, 0.66; 95% CI, 0.37-1.17), death (AOR, 0.47; 95% CI, 0.18-1.27), or vasopressor requirements (AOR, 0.68; 95% CI, 0.37-1.24).
In this propensity score-matched multicenter cohort study, HCW status was not associated with poorer outcomes among hospitalized patients with COVID-19 and, in fact, was associated with a shorter length of hospitalization and decreased likelihood of intensive care unit admission. Further research is needed to elucidate the proportion of HCW infections acquired in the workplace and to assess whether HCW type is associated with outcomes.
尽管医护人员（HCWs）感染 2019 年冠状病毒病（COVID-19）的风险较高，但尚不清楚他们是否存在预后较差的风险。
评估医护人员身份与 COVID-19 住院患者结局之间的关系。
设计、地点和参与者：本回顾性观察性队列研究纳入了 2020 年 4 月 15 日至 6 月 5 日期间北美 36 个中心的连续成年 COVID-19 确诊患者，共纳入 1992 例患者。数据于 2020 年 9 月 10 日至 10 月 1 日收集。
收集了患者的基线特征、合并症、临床表现、治疗和结局的数据，包括医护人员身份。
主要结局是需要机械通气或死亡。在 3:1 倾向评分匹配队列中进行多变量逻辑回归，以获得 COVID-19 相关结局中 HCW 身份与机械通气或死亡的调整比值比（AOR）和 95%置信区间（CI），在匹配后调整残余混杂因素。
共纳入 1790 例患者，包括 127 例 HCW 和 1663 例非 HCW。经过 3:1 倾向评分匹配后，122 例 HCW 与 366 例非 HCW 匹配。匹配的 HCW 中女性占 71（58.2%），匹配的非 HCW 中女性占 214（58.5%）。匹配的 HCW 的平均（SD）年龄为 52（13）岁，而匹配的非 HCW 的平均（SD）年龄为 57（17）岁。在匹配队列中，与非 HCW 相比，HCW 发生主要结局（机械通气或死亡）的可能性无显著差异（AOR，0.60；95%CI，0.34-1.04）。HCW 入住重症监护病房的可能性较低（AOR，0.56；95%CI，0.34-0.92），住院时间也较短（AOR，0.53；95%CI，0.34-0.83）。匹配的 HCW 与非 HCW 之间在机械通气（AOR，0.66；95%CI，0.37-1.17）、死亡（AOR，0.47；95%CI，0.18-1.27）或血管加压素需求（AOR，0.68；95%CI，0.37-1.24）方面无差异。
在这项倾向评分匹配的多中心队列研究中，HCW 身份与 COVID-19 住院患者的不良结局无关，事实上，与住院时间缩短和入住重症监护病房的可能性降低有关。需要进一步研究阐明 HCW 感染在工作场所获得的比例，并评估 HCW 类型是否与结局相关。
