Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
HIV Epidemiology Section, Georgia Department of Public Health, State of Georgia Building, Atlanta, GA.
Ann Epidemiol. 2022 Aug;72:57-64. doi: 10.1016/j.annepidem.2022.05.008. Epub 2022 May 29.
To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors.
We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021.
Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04).
After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.
探讨美国 COVID-19 粗病死率下降是否归因于临床治疗的改善和/或其他因素。
我们使用多变量逻辑回归，调整了年龄和其他个体特征，以检验 2020 年 3 月 2 日至 2021 年 3 月 31 日在佐治亚州报告的确诊和可能 COVID-19 病例以及住院病例中报告月份与死亡率之间的关系。
与 2020 年 8 月相比，2020 年 11 月病例的死亡率风险最低（OR=0.84；95%CI：0.78-0.91），并一直持续到 2021 年 3 月（OR=0.86；95%CI：0.77-0.95）。在住院病例中，2020 年 12 月（OR=1.16；95%CI：1.07-1.27）和 2021 年 1 月（OR=1.25；95%CI：1.14-1.36）死亡率风险增加，然后在 2021 年 3 月之前下降（OR=0.90；95%CI：0.78-1.04）。
在调整了包括病例年龄分布变化等其他因素后，我们观察到 2020 年 11 月至 2021 年 3 月与 2020 年 8 月相比，病例的死亡率风险较低。这表明临床管理的改善可能降低了死亡率风险。在住院病例中，2020 年 12 月和 2021 年 1 月死亡率风险再次增加，但到 2021 年 3 月降至与所有病例相似的风险水平。
