Eskandari Abrisham, Brojakowska Agnieszka, Bisserier Malik, Bander Jeffrey, Garikipati Venkata Naga Srikanth, Hadri Lahouaria, Goukassian David, Fish Kenneth
Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
PLoS One. 2021 Jul 16;16(7):e0254707. doi: 10.1371/journal.pone.0254707. eCollection 2021.
With the continued rise of the global incidence of COVID-19 infection and emergent second wave, the need to understand characteristics that impact susceptibility to infection, clinical severity, and outcomes remains vital. The objective of this study was to assess modifying effects of demographic factors on COVID-19 testing status and outcomes in a large, diverse single health system cohort. The Mount Sinai Health System de-identified COVID-19 database contained records of 39,539 patients entering the health system from 02/28/2020 to 06/08/2020 with 7,032 laboratory-confirmed cases. The prevalence of qRT-PCR nasopharyngeal swabs (χ2 = 665.7, p<0.0001) and case rates (χ2 = 445.3, p<0.0001) are highest in Hispanics and Black or African Americans. The likelihood of admission and/or presentation to an intensive care unit (ICU) versus non-ICU inpatient unit, emergency department, and outpatient services, which reflects the severity of the clinical course, was also modified by race and ethnicity. Females were less likely to be tested [Relative Risk(RR) = 1.121, p<0.0001], and males had a higher case prevalence (RR = 1.224, p<0.001). Compared to other major ethnic groups, Whites experienced a higher prevalence of mortality (p<0.05). Males experienced a higher risk of mortality (RR = 1.180, p = 0.0012) at relatively younger ages (70.58±11.75) compared to females (73.02±11.46) (p = 0.0004). There was an increased severity of disease in older patient populations of both sexes. Although Hispanic and Black or African American race was associated with higher testing prevalence and positive testing rates, the only disparity with respect to mortality was a higher prevalence in Whites.
随着全球新冠病毒感染发病率的持续上升以及第二波疫情的出现,了解影响感染易感性、临床严重程度和预后的特征仍然至关重要。本研究的目的是评估人口统计学因素对一个大型、多样化的单一卫生系统队列中新冠病毒检测状态和预后的修正作用。西奈山医疗系统的去识别化新冠病毒数据库包含了2020年2月28日至2020年6月8日进入该医疗系统的39539名患者的记录,其中有7032例实验室确诊病例。实时荧光定量聚合酶链反应(qRT-PCR)鼻咽拭子检测的患病率(χ2 = 665.7,p<0.0001)和病例率(χ2 = 445.3,p<0.0001)在西班牙裔以及黑人或非裔美国人中最高。种族和民族也对入住重症监护病房(ICU)与非ICU住院病房、急诊科和门诊服务相比的住院可能性和/或就诊情况产生了修正作用,这反映了临床病程的严重程度。女性接受检测的可能性较小[相对风险(RR) = 1.121,p<0.0001],而男性的病例患病率较高(RR = 1.224,p<0.001)。与其他主要种族群体相比,白人的死亡率较高(p<0.05)。与女性(73.02±11.46)相比,男性在相对年轻的年龄(70.58±11.75)时死亡风险更高(RR = 1.180,p = 0.0012)(p = 0.0004)。两性中年龄较大的患者群体疾病严重程度增加。尽管西班牙裔以及黑人或非裔美国人种族与较高的检测患病率和阳性检测率相关,但在死亡率方面唯一的差异是白人的患病率较高。