Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont.
CMAJ Open. 2021 Mar 22;9(1):E271-E279. doi: 10.9778/cmajo.20200323. Print 2021 Jan-Mar.
Understanding resource use for coronavirus disease 2019 (COVID-19) is critical. We conducted a descriptive analysis using public health data to describe age- and sex-specific acute care use, length of stay (LOS) and mortality associated with COVID-19.
We conducted a descriptive analysis using Ontario's Case and Contact Management Plus database of individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ontario from Mar. 1 to Sept. 30, 2020, to determine age- and sex-specific hospital admissions, intensive care unit (ICU) admissions, use of invasive mechanical ventilation, LOS and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency.
During the observation period, 56 476 individuals testing positive for SARS-CoV-2 were reported; 41 049 (72.7%) of these were younger than 60 years, and 29 196 (51.7%) were female. Proportion of cases shifted from older populations (> 60 yr) to younger populations (10-39 yr) over time. Overall, 5383 (9.5%) of individuals were admitted to hospital; of these, 1183 (22.0%) were admitted to the ICU, and 712 (60.2%) of these received invasive mechanical ventilation. Mean LOS for individuals in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation was 12.8 (standard deviation [SD] 15.4), 8.5 (SD 7.8) and 20.5 (SD 18.1) days, respectively. Among patients receiving care in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation, 911/3834 (23.8%), 124/418 (29.7%) and 287/635 (45.2%) died, respectively. All outcomes varied by age and decreased over time, overall and within age groups.
This descriptive study shows use of acute care and mortality varying by age and decreasing between March and September 2020 in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes.
了解 2019 年冠状病毒病（COVID-19）的资源利用情况至关重要。我们使用公共卫生数据进行了描述性分析，以描述与 COVID-19 相关的特定年龄和性别的急性护理使用、住院时间（LOS）和死亡率。
我们使用安大略省的病例和联系人管理加数据库对 2020 年 3 月 1 日至 9 月 30 日期间检测出严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）呈阳性的个体进行了描述性分析，以确定特定年龄和性别的住院、重症监护病房（ICU）入院、使用有创机械通气、LOS 和死亡率。我们按感染月份进行分层分析，以研究时间趋势，并按长期护理居住情况进行亚组分析。
在观察期间，报告了 56476 例 SARS-CoV-2 检测呈阳性的个体；其中 41049 例（72.7%）年龄小于 60 岁，29196 例（51.7%）为女性。病例比例随时间从老年人群（>60 岁）转移到年轻人群（10-39 岁）。总体而言，5383 例（9.5%）个体住院；其中 1183 例（22.0%）入住 ICU，其中 712 例（60.2%）接受有创机械通气。在病房、无有创机械通气的 ICU 和有创机械通气的 ICU 中，个体的平均 LOS 分别为 12.8（标准差[SD] 15.4）、8.5（SD 7.8）和 20.5（SD 18.1）天。在接受病房、无有创机械通气的 ICU 和有创机械通气的 ICU 治疗的患者中，分别有 911/3834（23.8%）、124/418（29.7%）和 287/635（45.2%）死亡。所有结果均因年龄而异，并随时间总体和各年龄段呈下降趋势。
这项描述性研究表明，在安大略省，2020 年 3 月至 9 月期间，急性护理使用和死亡率因年龄而异，并呈下降趋势。临床实践的改进和感染人群中风险分布的变化可能导致严重后果减少。
