哮喘与 COVID-19 死亡率的关联：基于调整后效应估计的更新荟萃分析。
The Association of Asthma With COVID-19 Mortality: An Updated Meta-Analysis Based on Adjusted Effect Estimates.
机构信息
Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China.
Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, China.
出版信息
J Allergy Clin Immunol Pract. 2021 Nov;9(11):3944-3968.e5. doi: 10.1016/j.jaip.2021.08.016. Epub 2021 Aug 28.
BACKGROUND
The association of asthma with the risk for mortality among coronavirus disease 2019 (COVID-19) patients is not clear.
OBJECTIVE
To investigate the association between asthma and the risk for mortality among COVID-19 patients.
METHODS
We performed systematic searches through electronic databases including PubMed, EMBASE, and Web of Science to identify potential articles reporting adjusted effect estimates on the association of asthma with fatal COVID-19. A random-effects model was conducted to estimate pooled effects. Sensitivity analysis, subgroup analysis, meta-regression, Begg's test and Egger's test were also performed.
RESULTS
Based on 62 studies with 2,457,205 cases reporting adjusted effect estimates, COVID-19 patients with asthma had a significantly reduced risk for mortality compared with those without it (15 cohort studies: 829,670 patients, pooled hazard ratio [HR] = 0.88, 95% confidence interval [CI], 0.82-0.95, I = 65.9%, P < .001; 34 cohort studies: 1,008,015 patients, pooled odds ratio [OR] = 0.88, 95% CI, 0.82-0.94, I = 39.4%, P = .011; and 11 cross-sectional studies: 1,134,738 patients, pooled OR = 0.87, 95% CI, 0.78-0.97, I = 41.1%, P = .075). Subgroup analysis based on types of adjusted factors indicated that COVID-19 patients with asthma had a significantly reduced risk for mortality among studies adjusting for demographic, clinical, and epidemiologic variables (pooled OR = 0.87, 95% CI, 0.83-0.92, I = 36.3%, P = .013; pooled HR = 0.90, 95% CI, 0.83-0.97, I = 69.2%, P < .001), but not among studies adjusting only for demographic variables (pooled OR = 0.88, 95% CI, 0.70-1.12, I = 40.5%, P = .097; pooled HR = 0.82, 95% CI, 0.64-1.06, I = 0%, P = .495). Sensitivity analysis proved that our results were stable and robust. Both Begg's test and Egger's test indicated that potential publication bias did not exist.
CONCLUSIONS
Our data based on adjusted effect estimates indicated that asthma was significantly related to a reduced risk for COVID-19 mortality.
背景
哮喘与 2019 冠状病毒病（COVID-19）患者死亡率之间的关联尚不清楚。
目的
调查哮喘与 COVID-19 患者死亡率之间的关系。
方法
我们通过电子数据库（包括 PubMed、EMBASE 和 Web of Science）进行了系统检索，以确定报告哮喘与致命 COVID-19 关联的调整后效应估计值的潜在文章。采用随机效应模型来估计合并效应。还进行了敏感性分析、亚组分析、meta 回归、贝叶斯检验和埃格检验。
结果
基于 62 项研究（共 2457205 例报告了调整后效应估计值），与无哮喘的 COVID-19 患者相比，哮喘患者的死亡率显著降低（15 项队列研究：829670 例患者，合并风险比 [HR] = 0.88，95%置信区间 [CI]，0.82-0.95，I = 65.9%，P <.001；34 项队列研究：1008015 例患者，合并优势比 [OR] = 0.88，95%CI，0.82-0.94，I = 39.4%，P =.011；11 项横断面研究：1134738 例患者，合并 OR = 0.87，95%CI，0.78-0.97，I = 41.1%，P =.075）。基于调整因素类型的亚组分析表明，在调整人口统计学、临床和流行病学变量的研究中，哮喘 COVID-19 患者的死亡率显著降低（合并 OR = 0.87，95%CI，0.83-0.92，I = 36.3%，P =.013；合并 HR = 0.90，95%CI，0.83-0.97，I = 69.2%，P <.001），但在仅调整人口统计学变量的研究中则不然（合并 OR = 0.88，95%CI，0.70-1.12，I = 40.5%，P =.097；合并 HR = 0.82，95%CI，0.64-1.06，I = 0%，P =.495）。敏感性分析证明了我们的结果是稳定和可靠的。贝叶斯检验和埃格检验均表明，不存在潜在的发表偏倚。
结论
我们基于调整后效应估计值的数据表明，哮喘与 COVID-19 死亡率降低显著相关。
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