65 岁及以上美国退伍军人 COVID-19 和流感住院后 30 天的死亡率。
30-day mortality following COVID-19 and influenza hospitalization among US veterans aged 65 and older.
机构信息
New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, Massachusetts, USA.
Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2022 Sep;70(9):2542-2551. doi: 10.1111/jgs.17828. Epub 2022 May 23.
BACKGROUND
COVID-19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID-19 and influenza among hospitalized older adults.
METHODS
We conducted a retrospective study of 30-day mortality among veterans aged 65+ hospitalized with COVID-19 from March 1, 2020-December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID-19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims-based Veterans Affairs Frailty Index (VA-FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders.
RESULTS
A total of 15,474 veterans were admitted with COVID-19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID-19 and influenza cohorts respectively. Crude 30-day mortality (95% CI) was 18.9% (18.3%-19.5%) for COVID-19 and 4.3% (3.8%-4.7%) for influenza. Combining cohorts, the odds ratio for 30-day mortality from COVID-19 (versus influenza) was 6.61 (5.74-7.65). There was a statistically significant interaction between infection with COVID-19 and frailty, but there was no significant interaction between COVID-19 and age. Separating cohorts, greater 30-day mortality was significantly associated with older age (p: COVID-19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID-19: <0.001, Influenza: <0.001).
CONCLUSION
Mortality from COVID-19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID-19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
背景
COVID-19 和流感是导致老年人发病和死亡的重要原因。了解感染 COVID-19 和流感的老年人的住院结局差异对于改善治疗非常重要。我们比较了 COVID-19 和流感感染导致的住院老年人的结局。
方法
我们对 2020 年 3 月 1 日至 2020 年 12 月 31 日期间因 COVID-19 住院且年龄在 65 岁及以上的退伍军人以及 2017 年 9 月 1 日至 2019 年 8 月 31 日期间因流感 A/B 住院的退伍军人的 30 天死亡率进行了回顾性研究。COVID-19 感染通过 PCR 检测阳性确定，流感通过 VA 系统使用的检测确定。脆弱性通过基于索赔的退伍军人事务脆弱性指数 (VA-FI) 定义。对死亡率与脆弱性、年龄和感染的逻辑回归进行了多因素调整。
结果
共有 15474 名退伍军人因 COVID-19 住院，7867 名退伍军人因流感住院。平均（SD）年龄分别为 76.1（7.8）和 75.8（8.3）岁，97.7%和 97.4%为男性，66.9%和 76.4%为白人分别在 COVID-19 和流感队列中。COVID-19 组和流感组的 30 天死亡率（95%CI）分别为 18.9%（18.3%-19.5%）和 4.3%（3.8%-4.7%）。合并队列后，COVID-19 组 30 天死亡率的比值比（与流感相比）为 6.61（5.74-7.65）。COVID-19 感染与脆弱性之间存在统计学显著的交互作用，但 COVID-19 与年龄之间不存在显著交互作用。在分别比较队列时，年龄较大（p：COVID-19：<0.001，流感：<0.001）和脆弱性较高（p 趋势：COVID-19：<0.001，流感：<0.001）与 30 天死亡率显著相关。
结论
COVID-19 导致的住院老年人死亡率高于流感。然而，与 COVID-19 相比，因流感住院的脆弱个体的死亡率在每个脆弱级别上都更高。预防仍是降低老年人病毒性疾病死亡率的关键。
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