严重急性呼吸综合征冠状病毒 2 在全国基于社区的美国成年人前瞻性队列中的发病率和危险因素。
Severe Acute Respiratory Syndrome Coronavirus 2 Incidence and Risk Factors in a National, Community-Based Prospective Cohort of US Adults.
机构信息
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA.
Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA.
出版信息
Clin Infect Dis. 2023 Feb 8;76(3):e375-e384. doi: 10.1093/cid/ciac423.
BACKGROUND
Prospective cohort studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence complement case-based surveillance and cross-sectional seroprevalence surveys.
METHODS
We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6738 US adults, enrolled in March-August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using least absolute shrinkage selection operator (LASSO) regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups of ≥10, and no masking in gyms or salons.
RESULTS
Among 4510 individuals with ≥1 serologic test, 323 (7.3% [95% confidence interval (CI), 6.5%-8.1%]) seroconverted by January 2021. Among 3422 participants seronegative in May-September 2020 and retested from November 2020 to January 2021, 161 seroconverted over 1646 person-years of follow-up (9.8 per 100 person-years [95% CI, 8.3-11.5]). The seroincidence rate was lower among women compared with men (incidence rate ratio [IRR], 0.69 [95% CI, .50-.94]) and higher among Hispanic (2.09 [1.41-3.05]) than white non-Hispanic participants. In adjusted models, participants who reported social distancing with people they did not know (IRR for always vs never social distancing, 0.42 [95% CI, .20-1.0]) and with people they knew (IRR for always vs never, 0.64 [.39-1.06]; IRR for sometimes vs never, 0.60 [.38-.96]) had lower seroconversion risk. Seroconversion risk increased with epidemiologic risk score (IRR for medium vs low score, 1.68 [95% CI, 1.03-2.81]; IRR for high vs low score, 3.49 [2.26-5.58]). Only 29% of those who seroconverted reported isolating, and only 19% were asked about contacts.
CONCLUSIONS
Modifiable risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the United States.
背景
严重急性呼吸综合征冠状病毒 2 （SARS-CoV-2）发病率的前瞻性队列研究补充了基于病例的监测和横断面血清流行率调查。
方法
我们在 2020 年 3 月至 8 月期间招募的 6738 名美国成年人的全国队列中估计了 SARS-CoV-2 感染的发病率。使用泊松模型，我们检查了社交距离和综合流行病学风险评分与血清转化的关联。该风险评分是使用最小绝对收缩和选择算子（LASSO）回归创建的，用于识别与血清转化相关的因素。选择的因素包括家庭拥挤、家庭中的确诊病例、室内用餐、与≥10 人聚会以及在健身房或沙龙不戴口罩。
结果
在 4510 名至少有 1 次血清学检测的个体中，到 2021 年 1 月，有 323 人（95%置信区间[CI]，6.5%-8.1%）发生血清转化。在 2020 年 5 月至 9 月血清学阴性并于 2020 年 11 月至 2021 年 1 月重新检测的 3422 名参与者中，在 1646 人年的随访中，有 161 人发生血清转化（每 100 人年 9.8 例[95%CI，8.3-11.5]）。与男性相比，女性的血清发病率较低（发病率比[IRR]，0.69 [95%CI，0.50-0.94]），与西班牙裔（2.09 [1.41-3.05]）相比，白人非西班牙裔参与者的血清发病率较高。在调整模型中，报告与不认识的人（IRR 始终与从不社交距离，0.42 [95%CI，0.20-1.0]）和认识的人（IRR 始终与从不社交距离，0.64 [0.39-1.06]）保持社交距离的参与者血清转化率较低。血清转化率随着流行病学风险评分的增加而增加（IRR 为中等 vs 低评分，1.68 [95%CI，1.03-2.81]；IRR 为高 vs 低评分，3.49 [2.26-5.58]）。只有 29%的血清转化者报告隔离，只有 19%的人被问及接触者。
结论
可改变的危险因素和公共卫生策略的不良覆盖面推动了 SARS-CoV-2 在整个美国的传播。
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