美国纽约市医院因素与 COVID-19 预后的关系：一项回顾性队列研究的启示
Hospital factor and prognosis of COVID-19 in New York City, the United States of America: insights from a retrospective cohort study.
机构信息
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.
出版信息
BMC Health Serv Res. 2022 Feb 8;22(1):164. doi: 10.1186/s12913-022-07570-w.
BACKGROUND
April 22nd, 2020, New York City (NYC) was the epicenter of the pandemic of Coronavirus disease 2019 (COVID-19) in the US with differences of death rates among its 5 boroughs. We aimed to investigate the difference in mortality associated with hospital factors (teaching versus community hospital) in NYC.
DESIGN
Retrospective cohort study.
METHODS
We obtained medical records of 6509 hospitalized patients with laboratory confirmed COVID-19 from the Mount Sinai Health System including 4 teaching hospitals in Manhattan and 2 community hospitals located outside of Manhattan (Queens and Brooklyn) retrospectively. Propensity score analysis using inverse probability of treatment weighting (IPTW) with stabilized weights was performed to adjust for differences in the baseline characteristics of patients initially presenting to teaching or community hospitals, and those who were transferred from community hospitals to teaching hospitals.
RESULTS
Among 6509 patients, 4653 (72.6%) were admitted in teaching hospitals, 1462 (22.8%) were admitted in community hospitals, and 293 (4.6%) were originally admitted in community and then transferred into teaching hospitals. Patients in community hospitals had higher mortality (42.5%) than those in teaching hospitals (17.6%) or those transferred from community to teaching hospitals (23.5%, P < 0.001). After IPTW-adjustment, when compared to patients cared for at teaching hospitals, the hazard ratio (HR) and 95% confidence interval (CI) of mortality were as follows: community hospitals 2.47 (2.03-2.99); transfers 0.80 (0.58-1.09)).
CONCLUSIONS
Patients admitted to community hospitals had higher mortality than those admitted to teaching hospitals.
背景
2020 年 4 月 22 日，纽约市（NYC）是美国 2019 年冠状病毒病（COVID-19）大流行的中心，其 5 个行政区的死亡率存在差异。我们旨在研究与医院因素（教学医院与社区医院）相关的纽约市死亡率差异。
设计
回顾性队列研究。
方法
我们从西奈山卫生系统获得了 6509 例经实验室确诊的 COVID-19 住院患者的医疗记录，包括曼哈顿的 4 所教学医院和位于曼哈顿以外的 2 所社区医院（皇后区和布鲁克林区）。使用逆概率治疗加权（IPTW）进行倾向评分分析，使用稳定权重调整最初就诊于教学或社区医院的患者以及从社区医院转至教学医院的患者的基线特征差异。
结果
在 6509 例患者中，4653 例（72.6%）收治在教学医院，1462 例（22.8%）收治在社区医院，293 例（4.6%）最初收治在社区医院，然后转至教学医院。社区医院的死亡率（42.5%）高于教学医院（17.6%）或从社区转至教学医院的患者（23.5%，P<0.001）。经 IPTW 调整后，与在教学医院接受治疗的患者相比，死亡率的危险比（HR）和 95%置信区间（CI）如下：社区医院 2.47（2.03-2.99）；转院 0.80（0.58-1.09））。
结论
收治于社区医院的患者死亡率高于收治于教学医院的患者。
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