Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
Mil Med. 2021 Nov 2;186(11-12):1088-1092. doi: 10.1093/milmed/usab044.
Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting.
This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area.
The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC's cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001).
Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.
几乎所有关于冠状病毒病 2019（COVID-19）住院结局的数据都来自城市环境。这些发现的推广程度尚不清楚。来自大城市环境的 COVID-19 数据在军事医学中可能特别难以应用，因为实践环境通常是半城市、农村或恶劣的。本研究的目的是比较美国非城市环境中 COVID-19 患者的临床表现和结局与城市环境中类似患者的临床表现和结局。
这是一项回顾性病例系列研究，纳入了 2020 年 3 月 23 日至 4 月 20 日（HMC 收治 COVID-19 患者的第一个月）在宾夕法尼亚州中部 Hershey 医疗中心（HMC）住院的实验室确诊 COVID-19 感染的成年患者。患者和该队列的结果与来自纽约市（NYC）地区类似患者队列的已发表数据进行了比较。
两个队列的年龄、性别、合并症、需要重症监护或机械通气以及大多数生命体征和实验室研究相似。NYC 队列的住院时间更短（4.1 天与 7.2 天，P<0.001），但非裔美国人患者更多（23%与 12%，P=0.02），异常丙氨酸（>60U/L；39.0%与 5.9%，P<0.001）和天冬氨酸（>40U/L；58.4%与 42.4%，P=0.012）转氨酶、氧饱和度<90%（20.4%与 7.2%，P=0.004）和死亡率（21%与 1.4%，P<0.001）更高。
非城市环境中的医院医生在考虑来自不同地区的结果的推广性时应谨慎。需要进一步研究以探讨是否存在可复制的系统性致病因素，这可能有助于改善 COVID-19 相关结局。在许多环境中更广泛地报告这些关系将使军事医疗规划人员在考虑 COVID-19 规划时能够更好地考虑与其独特环境最相关的结局。
