Center for Applied Mathematics, Cornell University, Ithaca, USA.
Department of Biology, McMaster University, Hamilton, Canada.
BMC Public Health. 2021 Apr 12;21(1):706. doi: 10.1186/s12889-021-10611-4.
Patient age is one of the most salient clinical indicators of risk from COVID-19. Age-specific distributions of known SARS-CoV-2 infections and COVID-19-related deaths are available for many regions. Less attention has been given to the age distributions of serious medical interventions administered to COVID-19 patients, which could reveal sources of potential pressure on the healthcare system should SARS-CoV-2 prevalence increase, and could inform mass vaccination strategies. The aim of this study is to quantify the relationship between COVID-19 patient age and serious outcomes of the disease, beyond fatalities alone.
We analysed 277,555 known SARS-CoV-2 infection records for Ontario, Canada, from 23 January 2020 to 16 February 2021 and estimated the age distributions of hospitalizations, Intensive Care Unit admissions, intubations, and ventilations. We quantified the probability of hospitalization given known SARS-CoV-2 infection, and of survival given COVID-19-related hospitalization.
The distribution of hospitalizations peaks with a wide plateau covering ages 60-90, whereas deaths are concentrated in ages 80+. The estimated probability of hospitalization given known infection reaches a maximum of 27.8% at age 80 (95% CI 26.0%-29.7%). The probability of survival given hospitalization is nearly 100% for adults younger than 40, but declines substantially after this age; for example, a hospitalized 54-year-old patient has a 91.7% chance of surviving COVID-19 (95% CI 88.3%-94.4%).
Our study demonstrates a significant need for hospitalization in middle-aged individuals and young seniors. This need is not captured by the distribution of deaths, which is heavily concentrated in very old ages. The probability of survival given hospitalization for COVID-19 is lower than is generally perceived for patients over 40. If acute care capacity is exceeded due to an increase in COVID-19 prevalence, the distribution of deaths could expand toward younger ages. These results suggest that vaccine programs should aim to prevent infection not only in old seniors, but also in young seniors and middle-aged individuals, to protect them from serious illness and to limit stress on the healthcare system.
患者年龄是 COVID-19 风险的最显著临床指标之一。许多地区都有针对已知 SARS-CoV-2 感染和 COVID-19 相关死亡的特定年龄分布。对于 COVID-19 患者接受的严重医疗干预的年龄分布，人们关注较少，这可能揭示了 SARS-CoV-2 流行率增加时医疗系统潜在压力的来源，并为大规模疫苗接种策略提供信息。本研究的目的是定量分析 COVID-19 患者年龄与疾病严重程度之间的关系，而不仅仅是死亡。
我们分析了 2020 年 1 月 23 日至 2021 年 2 月 16 日加拿大安大略省的 277555 例已知 SARS-CoV-2 感染记录，并估计了住院、重症监护病房入院、插管和通气的年龄分布。我们量化了已知 SARS-CoV-2 感染后住院的概率，以及 COVID-19 相关住院后的存活率。
住院分布的高峰呈宽平台状，涵盖 60-90 岁，而死亡则集中在 80 岁以上。已知感染后住院的估计概率在 80 岁时达到最大值 27.8%（95%CI 26.0%-29.7%）。40 岁以下成年人住院后 COVID-19 存活率接近 100%，但此后大幅下降；例如，一位 54 岁的住院患者 COVID-19 存活率为 91.7%（95%CI 88.3%-94.4%）。
我们的研究表明，中年人和年轻老年人对住院治疗有很大的需求。这种需求没有通过死亡分布来捕捉，死亡分布主要集中在非常高龄人群。COVID-19 住院后存活率低于人们普遍认为的 40 岁以上患者的存活率。如果 COVID-19 流行率增加导致急性护理能力超过负荷，死亡分布可能会向年轻人群扩展。这些结果表明，疫苗接种计划不仅应针对老年人群，还应针对年轻老年人和中年人群，以防止他们患病并减轻医疗系统的压力。
