Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
J Alzheimers Dis. 2022;89(2):681-693. doi: 10.3233/JAD-220369.
The identification of risk factors for SARS-CoV-2 infection and mortality in patients with dementia is a key aspect to support clinical decisions and public health interventions.
To assess the incidence of SARS-CoV-2 infection and COVID-19 related death in a cohort of patients with dementia residing in the Lazio region and to investigate predicting factors for both infection and mortality.
This population-based study used information from administrative databases and the SARS-CoV-2 infection surveillance system. Patients with dementia (age ≥65) were enrolled as of December 31, 2019 and followed-up until February 28, 2021. Cumulative risk of infection and death within 60 days of infection onset, and age-standardized incidence (SIR) and mortality (SMR) ratios were calculated. Logistic regression models were applied to identify factors associated with infection and mortality.
Among 37,729 dementia patients, 2,548 had a diagnosis of SARS-CoV-2 infection. The crude risk of infection was 6.7%. An increase in risk of infection was observed both in women (SIR 1.72; 95% CI 1.64-1.80) and men (SIR 1.43; 95% CI 1.33-1.54). Pneumonia, cerebrovascular and blood diseases, femur fracture, anxiety, antipsychotic and antithrombotic use were associated with an increased risk of infection. The crude risk of death was 31.0%, the SMRs 2.32 (95% CI 2.05-2.65) for men, and 2.82 (95% CI 2.55-3.11) for women. Factors associated with mortality included: male gender, age ≥85, symptoms at the diagnosis, antipsychotic and systemic antibiotics treatment.
These findings emphasize the need of close and tailored monitoring of dementia patients to reduce the impact of COVID-19 on this fragile population.
确定痴呆症患者感染 SARS-CoV-2 病毒和死亡的风险因素是支持临床决策和公共卫生干预的关键方面。
评估居住在拉齐奥地区的痴呆症患者队列中 SARS-CoV-2 感染和 COVID-19 相关死亡的发生率，并研究感染和死亡率的预测因素。
本基于人群的研究使用了行政数据库和 SARS-CoV-2 感染监测系统的信息。自 2019 年 12 月 31 日起招募年龄≥65 岁的痴呆症患者，并随访至 2021 年 2 月 28 日。计算感染后 60 天内感染和死亡的累积风险，并计算标准化发病率（SIR）和死亡率（SMR）比值。应用逻辑回归模型确定与感染和死亡相关的因素。
在 37729 例痴呆症患者中，有 2548 例被诊断为 SARS-CoV-2 感染。感染的粗风险为 6.7%。女性（SIR 1.72；95%CI 1.64-1.80）和男性（SIR 1.43；95%CI 1.33-1.54）的感染风险均增加。肺炎、脑血管和血液疾病、股骨骨折、焦虑、抗精神病药和抗血栓药物的使用与感染风险增加相关。死亡的粗风险为 31.0%，男性 SMRs 为 2.32（95%CI 2.05-2.65），女性为 2.82（95%CI 2.55-3.11）。与死亡率相关的因素包括：男性、年龄≥85 岁、诊断时出现症状、抗精神病药和全身抗生素治疗。
这些发现强调需要密切监测痴呆症患者，以减少 COVID-19 对这一脆弱人群的影响。
