年龄、性别、种族和地域对美国住院 COVID-19 患者主要临床结局的影响。
Impact of age, sex, race, and regionality on major clinical outcomes of COVID-19 in hospitalized patients in the United States.
机构信息
Department of Internal Medicine, Robert Wood Johnson Barnabas Health, Rahway, NJ, USA.
Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, 4801 Linwood Blvd, Kansas City, MO, 64128, USA.
出版信息
BMC Infect Dis. 2022 Jul 29;22(1):659. doi: 10.1186/s12879-022-07611-z.
BACKGROUND
The COVID-19 pandemic has affected all people across the globe. Regional and community differences in timing and severity of surges throughout the pandemic can provide insight into risk factors for worse outcomes in those hospitalized with COVID-19.
METHODS
The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database made up of hospitalized patients with proven infection from December 1, 2019 through November 30, 2020. Baseline demographic information, comorbidities, and hospital characteristics were obtained. We performed multivariate analysis to determine if age, race, comorbidity and regionality were predictors for mortality, ARDS, mechanical ventilation or sepsis hospitalized patients with COVID-19.
RESULTS
Of 100,902 hospitalized COVID-19 patients included in the analysis (median age 52 years, IQR 36-67; 50.7% female), COVID-19 case fatality rate was 8.5% with majority of deaths in those ≥ 65 years (70.8%). In multivariate analysis, age ≥ 65 years, male gender and higher Charlson Comorbidity Index (CCI) were independent risk factors for mortality and ARDS. Those identifying as non-Black or non-White race have a marginally higher risk for mortality (OR 1.101, CI 1.032-1.174) and greater risk of ARDS (OR 1.44, CI 1.334-1.554) when compared to those who identify as White. The risk of mortality or ARDS was similar for Blacks as Whites. Multivariate analysis found higher mortality risk in the Northeast (OR 1.299, CI 1.22-1.29) and West (OR 1.26, CI 1.18-1.34). Larger hospitals also had an increased risk of mortality, greatest in hospitals with 500-999 beds (OR 1.67, CI 1.43-1.95).
CONCLUSION
Advanced age, male sex and a higher CCI predicted worse outcomes in hospitalized COVID-19 patients. In multivariate analysis, worse outcomes were identified in small minority populations, however there was no difference in study outcomes between those who identify as Black or White.
背景
COVID-19 大流行影响了全球所有人。大流行期间，不同地区和社区的疫情暴发时间和严重程度不同，这可以深入了解 COVID-19 住院患者预后较差的风险因素。
方法
本研究队列来自 Cerner 真实世界数据（CRWD）COVID-19 数据库，该数据库由 2019 年 12 月 1 日至 2020 年 11 月 30 日期间确诊感染的住院患者组成。获得了基线人口统计学信息、合并症和医院特征。我们进行了多变量分析，以确定年龄、种族、合并症和地域性是否是 COVID-19 住院患者死亡、ARDS、机械通气或败血症的预测因素。
结果
在纳入分析的 100902 例 COVID-19 住院患者中（中位年龄 52 岁，IQR 36-67；50.7%为女性），COVID-19 的病死率为 8.5%，大多数死亡发生在≥65 岁的患者中（70.8%）。多变量分析显示，年龄≥65 岁、男性和更高的 Charlson 合并症指数（CCI）是死亡和 ARDS 的独立危险因素。与白人相比，非黑人或非白人种族的患者死亡（OR 1.101，CI 1.032-1.174）和 ARDS（OR 1.44，CI 1.334-1.554）的风险更高，尽管差异仅为边缘显著。黑人的死亡或 ARDS 风险与白人相似。多变量分析发现，东北地区（OR 1.299，CI 1.22-1.29）和西部（OR 1.26，CI 1.18-1.34）的死亡率风险更高。较大的医院也有更高的死亡风险，其中 500-999 张病床的医院风险最大（OR 1.67，CI 1.43-1.95）。
结论
年龄较大、男性和更高的 CCI 预测 COVID-19 住院患者预后较差。在多变量分析中，少数人群的预后较差，但黑人或白人患者的研究结果没有差异。
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