Edwards Jessie K, Wohl David Alain
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of Infectious Diseases, Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Open Forum Infect Dis. 2022 Aug 25;9(9):ofac439. doi: 10.1093/ofid/ofac439. eCollection 2022 Sep.
Coronavirus disease 2019 (COVID-19) is a leading cause of US deaths and when severe requires admission to a hospital; however, 9% of US COVID-19 deaths before 2022 occurred at home.
Death certificate data were used to examine the cumulative probability of dying at home from COVID-19 and from any cause in North Carolina, including by race and ethnicity.
Between March 1, 2020 and December 31, 2021, 22 646 COVID-19 deaths were recorded in North Carolina; of these, 1771 (7.8%) occurred at home. Cumulative risk of dying at home with COVID-19 increased from 3.3/100 000 on December 31, 2020 to 13.0/100 000 on December 31, 2021. After standardizing each racial/ethnic group, cumulative at-home COVID-19 mortality among Hispanic people compared to White people was 9.9/100 000 versus 2.3/100 000, respectively, at year-end 2020 (difference, 7.6/100 000; 95% confidence interval [CI], 5.6-9.6) and 19.0/100 000 versus 11.4/100 000 at year-end 2021 (difference, 7.6; 95% CI, 4.9-10.4). At-home mortality among Black people was also elevated compared to White people (difference, 5.6/100 000; 95% CI, 3.7-7.4) at year-end 2021. Rates of dying at home from any cause increased overall but were greatest among Hispanic people.
By the end of 2021, the risk of dying at home from COVID-19 increased, especially for persons of color. The risk of dying at-home from any cause also increased for all but more so for Hispanic persons. These findings suggest perennial barriers to care prevent those with progressive COVID-19 from accessing medical attention and the need for initiatives that extend healthcare access for those disproportionately impacted by COVID-19 to prevent avoidable death.
2019冠状病毒病（COVID-19）是美国死亡的主要原因之一，病情严重时需要住院治疗；然而，在2022年之前，美国9%的COVID-19死亡病例发生在家中。
利用死亡证明数据研究北卡罗来纳州COVID-19在家中死亡以及任何原因导致死亡的累积概率，包括按种族和族裔划分。
在2020年3月1日至2021年12月31日期间，北卡罗来纳州记录了22646例COVID-19死亡病例；其中，1771例（7.8%）在家中死亡。COVID-19在家中死亡的累积风险从2020年12月31日的3.3/100000增加到2021年12月31日的13.0/100000。在对每个种族/族裔群体进行标准化后，2020年底西班牙裔人群与白人相比，COVID-19在家中的累积死亡率分别为9.9/100000和2.3/100000（差异为7.6/100000；95%置信区间[CI]，5.6 - 9.6），2021年底分别为19.0/100000和11.4/100000（差异为7.6；95%CI，4.9 - 10.4）。2021年底，黑人在家中的死亡率与白人相比也有所升高（差异为5.6/100000；95%CI，3.7 - 7.4）。任何原因导致的在家中死亡率总体上有所上升，但西班牙裔人群中上升幅度最大。
到2021年底，COVID-19在家中死亡的风险增加，尤其是有色人种。除西班牙裔人群外，所有种族因任何原因在家中死亡的风险也有所增加，但西班牙裔人群增加幅度更大。这些发现表明，长期存在的护理障碍使COVID-19病情进展者无法获得医疗救治，有必要采取举措扩大医疗服务可及性，为受COVID-19影响尤为严重的人群提供服务，以防止可避免的死亡。
