Pennington Audrey F, Kompaniyets Lyudmyla, Summers April D, Danielson Melissa L, Goodman Alyson B, Chevinsky Jennifer R, Preston Leigh Ellyn, Schieber Lyna Z, Namulanda Gonza, Courtney Joseph, Strosnider Heather M, Boehmer Tegan K, Mac Kenzie William R, Baggs James, Gundlapalli Adi V
CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Commissioned Corps, United States Public Health Service, Rockville, Maryland, USA.
Open Forum Infect Dis. 2020 Dec 28;8(2):ofaa638. doi: 10.1093/ofid/ofaa638. eCollection 2021 Feb.
Older adults and people from certain racial and ethnic groups are disproportionately represented in coronavirus disease 2019 (COVID-19) hospitalizations and deaths.
Using data from the Premier Healthcare Database on 181813 hospitalized adults diagnosed with COVID-19 during March-September 2020, we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death) and to determine whether the impact of age on clinical severity differs by race/ethnicity.
Overall, 84497 (47%) patients were admitted to the ICU, 29078 (16%) received IMV, and 27864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio, 0.96; 95% CI, 0.92-0.99) and higher among Hispanic/Latino patients (risk ratio [RR], 1.15; 95% CI, 1.09-1.20), non-Hispanic Asian patients (RR, 1.16; 95% CI, 1.09-1.23), and patients of other racial and ethnic groups (RR, 1.13; 95% CI, 1.06-1.21). Risk of ICU admission and risk of IMV were elevated among some racial and ethnic groups.
These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce severe acute respiratory syndrome coronavirus 2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.
在2019冠状病毒病（COVID-19）住院病例和死亡病例中，老年人以及某些种族和族裔群体的占比过高。
利用Premier医疗数据库中2020年3月至9月期间181813例确诊为COVID-19的住院成人患者的数据，我们应用多变量对数二项回归来评估年龄和种族/族裔与COVID-19临床严重程度（重症监护病房[ICU]收治、有创机械通气[IMV]和死亡）之间的关联，并确定年龄对临床严重程度的影响是否因种族/族裔而异。
总体而言，84497例（47%）患者被收治入ICU，29078例（16%）接受了IMV，27864例（15%）在医院死亡。在控制潜在医疗状况和其他协变量时，年龄增加与临床严重程度密切相关；这种关联的强度因种族/族裔而异。与非西班牙裔白人患者相比，非西班牙裔黑人患者的死亡风险较低（调整风险比，0.96；95%CI，0.92 - 0.99），而西班牙裔/拉丁裔患者（风险比[RR]，1.15；95%CI，1.09 - 1.20）、非西班牙裔亚洲患者（RR，1.16；95%CI，1.09 - 1.23）以及其他种族和族裔群体的患者（RR，1.13；95%CI，1.06 - 1.21）的死亡风险较高。一些种族和族裔群体的ICU收治风险和IMV风险有所升高。
这些结果表明，年龄是COVID-19住院患者预后不良的一个驱动因素。此外，一些种族和族裔少数群体患者的临床严重程度可能更高。采取公共卫生策略降低老年人和种族及族裔少数群体中严重急性呼吸综合征冠状病毒2的感染率对于改善预后至关重要。
