Chishinga Nathaniel, Smith Sasha, Gandhi Neel R, Onwubiko Udodirim N, Telford Carson, Prieto Juliana, Chamberlain Allison T, Khan Shamimul, Williams Steve, Khan Fazle, Sarita Shah N
Office of Epidemiology, Fulton County Board of Health, Atlanta, Georgia, USA.
Fulton County Government, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2022 Mar 3;9(4):ofac101. doi: 10.1093/ofid/ofac101. eCollection 2022 Apr.
We examined differences in mortality among coronavirus disease 2019 (COVID-19) cases in the first, second, and third waves of the COVID-19 pandemic.
A retrospective cohort study of COVID-19 cases in Fulton County, Georgia, USA, reported to a public health surveillance from March 2020 through February 2021. We estimated case-fatality rates (CFR) by wave and used Cox proportional hazards random-effects models in each wave, with random effects at individual and long-term-care-facility level, to determine risk factors associated with rates of mortality.
Of 75 289 confirmed cases, 4490 (6%) were diagnosed in wave 1 (CFR 31 deaths/100 000 person days [pd]), 24 293 (32%) in wave 2 (CFR 7 deaths/100 000 pd), and 46 506 (62%) in wave 3 (CFR 9 deaths/100 000 pd). Compared with females, males were more likely to die in each wave: wave 1 (adjusted hazard ratio [aHR], 1.5; 95% confidence interval [CI], 1.2-1.8), wave 2 (aHR 1.5, 95% CI, 1.2-1.8), and wave 3 (aHR 1.7, 95% CI, 1.5-2.0). Compared with non-Hispanic whites, non-Hispanic blacks were more likely to die in each wave: wave 1 (aHR, 1.4; 95% CI, 1.1-1.8), wave 2 (aHR, 1.5; 95% CI, 1.2-1.9), and wave 3 (aHR, 1.7; 95% CI, 1.4-2.0). Cases with any disability, chronic renal disease, and cardiovascular disease were more likely to die in each wave compared with those without these comorbidities.
Our study found gender and racial/ethnic disparities in COVID-19 mortality and certain comorbidities associated with COVID-19 mortality. These factors have persisted throughout the COVID-19 pandemic waves, despite improvements in diagnosis and treatment.
我们研究了2019冠状病毒病（COVID-19）大流行第一波、第二波和第三波中COVID-19病例的死亡率差异。
对2020年3月至2021年2月期间向美国佐治亚州富尔顿县公共卫生监测部门报告的COVID-19病例进行回顾性队列研究。我们按波次估计病死率（CFR），并在每一波次中使用Cox比例风险随机效应模型，在个体和长期护理机构层面设置随机效应，以确定与死亡率相关的风险因素。
在75289例确诊病例中，4490例（6%）在第一波被诊断（CFR为每100000人日[pd]31例死亡），24293例（32%）在第二波被诊断（CFR为每100000 pd 7例死亡），46506例（62%）在第三波被诊断（CFR为每100000 pd 9例死亡）。与女性相比，男性在每一波次中死亡的可能性更高：第一波（调整后风险比[aHR]，1.5；95%置信区间[CI]，1.2 - 1.8），第二波（aHR 1.5，95% CI，1.2 - 1.8），第三波（aHR 1.7，95% CI，1.5 - 2.0）。与非西班牙裔白人相比，非西班牙裔黑人在每一波次中死亡的可能性更高：第一波（aHR，1.4；95% CI，1.1 - 1.8），第二波（aHR，1.5；95% CI，1.2 - 1.9），第三波（aHR，1.7；95% CI，1.4 - 2.0）。与没有这些合并症的病例相比，患有任何残疾、慢性肾病和心血管疾病的病例在每一波次中死亡的可能性更高。
我们的研究发现了COVID-19死亡率中的性别和种族/民族差异以及与COVID-19死亡率相关的某些合并症。尽管诊断和治疗有所改善，但这些因素在整个COVID-19大流行波次中一直存在。
