巴西一州公立医院的 COVID-19 死亡率：对疫情三波的分析。
COVID-19 Mortality in Public Hospitals in a Brazilian State: An Analysis of the Three Waves of the Pandemic.
机构信息
Secretaria de Estado da Saúde do Espírito Santo, Special Epidemiological Surveillance Nucleus, Instituto Capixaba de Ensino, Pesquisa e Inovação (ICEPi), Vitória 29010-120, ES, Brazil.
Graduate Program in Public Health, Federal University of Espírito Santo (U.F.E.S.), Vitoria 29047-105, ES, Brazil.
出版信息
Int J Environ Res Public Health. 2022 Oct 28;19(21):14077. doi: 10.3390/ijerph192114077.
OBJECTIVE
To analyze COVID-19 deaths in public hospitals in a Brazilian state, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables.
METHODS
Observational analytical study, where 5436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between 1 April 2020, and 31 August 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson's chi-square, Fisher's Exact or Friedman's tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses.
RESULTS
The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability or confusion, adynamia or weakness, chronic cardiovascular disease, neoplasms, and diabetes mellitus. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves ( < 0.05).
CONCLUSION
The time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021, which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics.
目的
分析巴西一州公立医院因 COVID-19 死亡的病例，按大流行的三个阶段分层，并检验其与社会临床变量的相关性。
方法
本观察性分析研究共分析了 2020 年 4 月 1 日至 2021 年 8 月 31 日期间，在埃斯皮里图桑托州公立医疗网络医院中发生的 5436 例因 COVID-19 死亡的病例，病例按大流行的三个阶段分层。进行双变量分析时，取决于数据的正态或非正态分布，采用皮尔逊卡方检验、Fisher 确切检验或 Friedman 检验。对于每个阶段诊断到死亡的时间关系，使用分位数回归，以及多变量分析的多项回归。
结果
在第一波，从诊断到死亡的平均时间为 18.5 天；在第二波为 20.5 天；在第三波为 21.4 天。在第一波，公立医院的死亡与以下变量相关：免疫功能低下、肥胖、肿瘤和起源。在第二波，死亡与教育程度、血氧饱和度 < 95%、慢性神经疾病和起源相关。在第三波，死亡与种族/肤色、教育程度、呼吸困难、鼻或结膜充血、易怒或意识模糊、乏力或虚弱、慢性心血管疾病、肿瘤和糖尿病相关。起源与大流行的三个阶段的结果相关，而教育程度与第二和第三波相关（<0.05）。
结论
从诊断到死亡的时间间隔可能受到多种因素的影响，如：卫生系统的弹性、患者临床管理的改善，以及 2021 年 1 月底开始的疫苗接种，这涵盖了死亡率较高的年龄组。在公立医院发生的死亡与社会临床特征相关。
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