Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York.
now with Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle.
JAMA Netw Open. 2022 Jan 4;5(1):e2142046. doi: 10.1001/jamanetworkopen.2021.42046.
The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography.
To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States.
Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index.
The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time.
Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58).
In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.
COVID-19 大流行在美国具有明显的时空模式。癌症患者患 COVID-19 严重并发症的风险较高，但尚不清楚这一患者群体的 COVID-19 结局是否与地理位置有关。
量化癌症患者 COVID-19 结局的时空变化。
设计、地点和参与者：本基于登记的回顾性队列研究纳入了 2020 年 3 月至 11 月期间有历史诊断为侵袭性恶性肿瘤和实验室确诊 SARS-CoV-2 感染的患者。数据来自美国的癌症治疗中心。
患者居住地分为 9 个美国人口普查区。癌症中心特征包括学术或社区分类、农村-城市连续体代码 (RUCC) 和社会脆弱性指数。
主要结局为 30 天全因死亡率。次要复合结局包括机械通气、入住重症监护病房和全因死亡。多水平混合效应模型估计了中心水平和人口普查分区水平暴露与调整患者水平风险因素后的结局之间的关联，并量化了调整后结局在中心、人口普查分区和日历时间上的差异。
报告了来自东北部（1564 例[32.9%]）、中西部（1638 例[34.5%]）、南部（894 例[18.8%]）和西部（653 例[13.8%]）83 个中心的 4749 例患者的数据（中位数[IQR]年龄，66[56-76]岁；2439 例[51.4%]女性，1079 例[22.7%]非西班牙裔黑人，690 例[14.5%]西班牙裔）。在调整了 COVID-19 诊断月份等患者特征后，各中心 30 天死亡率估计值在 5.2%至 26.6%之间。与人口至少 100 万的大都市地区中心的患者相比，来自人口少于 25 万的大都市地区中心的患者（调整后的优势比[OR]，0.31；95%CI，0.11-0.84）30 天死亡率较低。中心类型与主要或次要结局无显著关联。9 个人口普查区之间的结局发生率无统计学差异，但调整后的死亡率随时间显著改善（例如，9 月至 11 月与 3 月至 5 月：OR，0.32；95%CI，0.17-0.58）。
在这项基于登记的队列研究中，未观察到美国人口普查区 COVID-19 结局的显著差异。然而，在癌症治疗中心之间发现了 COVID-19 结局的显著异质性。关注实施癌症和 COVID-19 患者护理的标准化指南，可以改善这些脆弱患者的结局。
