印度的教育程度与 COVID-19 相关结局：基于医院的横断面研究。
Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study.
机构信息
Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India.
Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
出版信息
BMJ Open. 2022 Feb 25;12(2):e055403. doi: 10.1136/bmjopen-2021-055403.
OBJECTIVE
Association of educational status, as marker of socioeconomic status, with COVID-19 outcomes has not been well studied. We performed a hospital-based cross-sectional study to determine its association with outcomes.
METHODS
Successive patients of COVID-19 presenting at government hospital were recruited. Demographic and clinical details were obtained at admission, and in-hospital outcomes were assessed. Cohort was classified according to self-reported educational status into group 1: illiterate or ≤primary; group 2: higher secondary; and group 3: some college. To compare intergroup outcomes, we performed logistic regression.
RESULTS
4645 patients (men 3386, women 1259) with confirmed COVID-19 were recruited. Mean age was 46±18 years, most lived in large households and 30.5% had low educational status. Smoking or tobacco use was in 29.5%, comorbidities in 28.6% and low oxygen concentration (SpO <95%) at admission in 30%. Average length of hospital stay was 6.8±3.7 days, supplemental oxygen was provided in 18.4%, high flow oxygen or non-invasive ventilation 7.1% and mechanical ventilation 3.6%, 340 patients (7.3%) died. Group 1 patients had more tobacco use, hypoxia at admission, lymphocytopaenia, and liver and kidney dysfunction. In group 1 versus groups 2 and 3, requirement of oxygen (21.6% vs 16.7% and 17.0%), non-invasive ventilation (8.0% vs 5.9% and 7.1%), invasive ventilation (4.6% vs 3.5% and 3.1%) and deaths (10.0% vs 6.8% and 5.5%) were significantly greater (p<0.05). OR for deaths were higher in group 1 (1.91, 95% CI 1.46 to 2.51) and group 2 (1.24, 95% CI 0.93 to 1.66) compared with group 3. Adjustment for demographic and comorbidities led to some attenuation in groups 1 (1.44, 95% CI 1.07 to 1.93) and 2 (1.38, 95% CI 1.02 to 1.85); this persisted with adjustments for clinical parameters and oxygen support in groups 1 (1.38, 95% CI 0.99 to 1.93) and 2 (1.52, 95% CI 1.01 to 2.11).
CONCLUSION
Low educational status patients with COVID-19 in India have significantly greater adverse in-hospital outcomes and mortality.
TRIAL REGISTRATION NUMBER
REF/2020/06/034036.
目的
教育程度作为社会经济地位的标志，与 COVID-19 结局的关联尚未得到很好的研究。我们进行了一项基于医院的横断面研究，以确定其与结局的关系。
方法
连续招募在政府医院就诊的 COVID-19 患者。入院时获取人口统计学和临床详细信息，并评估住院期间的结局。根据自我报告的教育程度，将队列分为 3 组：1 组：文盲或小学及以下；2 组：中学及以上；3 组：大专及以上。为了比较组间结局，我们进行了逻辑回归分析。
结果
共纳入 4645 例（男性 3386 例，女性 1259 例）确诊 COVID-19 患者。平均年龄为 46±18 岁，大多数患者居住在大家庭中，30.5%的患者教育程度较低。29.5%的患者吸烟或使用烟草，28.6%的患者合并症，30%的患者入院时血氧浓度（SpO<95%）低。平均住院时间为 6.8±3.7 天，18.4%的患者需要吸氧，7.1%的患者需要高流量氧或无创通气，3.6%的患者需要机械通气，340 例（7.3%）患者死亡。1 组患者吸烟、入院时缺氧、淋巴细胞减少、肝肾功能障碍更为常见。与 2 组和 3 组相比，1 组患者需要吸氧（21.6%比 16.7%和 17.0%）、无创通气（8.0%比 5.9%和 7.1%）、有创通气（4.6%比 3.5%和 3.1%）和死亡（10.0%比 6.8%和 5.5%）的比例明显更高（p<0.05）。与 3 组相比，1 组（1.91，95%CI 1.46 至 2.51）和 2 组（1.24，95%CI 0.93 至 1.66）的死亡比值比更高。调整人口统计学和合并症后，1 组（1.44，95%CI 1.07 至 1.93）和 2 组（1.38，95%CI 1.02 至 1.85）的比值比有所降低；在调整临床参数和氧支持后，1 组（1.38，95%CI 0.99 至 1.93）和 2 组（1.52，95%CI 1.01 至 2.11）的比值比仍然存在。
结论
印度 COVID-19 低教育程度患者住院期间不良结局和死亡率显著更高。
临床试验注册号
REF/2020/06/034036。
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