2019年冠状病毒病（COVID-19）与大流行影响相关的超额死亡率结局研究（COPES）：一项系统评价和荟萃分析。
Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis.
作者信息
Lu David, Dhanoa Sumeet, Cheema Harleen, Lewis Kimberley, Geeraert Patrick, Merrick Benjamin, Vander Leek Aaron, Sebastianski Meghan, Kula Brittany, Chaudhuri Dipayan, Basmaji John, Agrawal Arnav, Niven Dan, Fiest Kirsten, Stelfox Henry T, Zuege Danny J, Rewa Oleksa G, Bagshaw Sean M, Lau Vincent I
机构信息
Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
出版信息
Front Med (Lausanne). 2022 Dec 16;9:999225. doi: 10.3389/fmed.2022.999225. eCollection 2022.
BACKGROUND AND AIM
With the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times.
METHODS
We searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
RESULTS
Of 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons ( = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06-0.06% < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38-1.70, < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07-1.30, < 0.00001). There was "very low" certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain.
INTERPRETATION
The COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256].
背景与目的
随着2019冠状病毒病（COVID-19）大流行持续影响全球医疗系统，医疗服务提供者试图在投入到COVID-19患者的资源之间取得平衡，同时尽量降低总体超额死亡率（包括COVID-19和非COVID-19患者）。为此，我们进行了一项系统评价（SR），以描述COVID-19大流行期间与非大流行时期相比，对全因超额死亡率（COVID-19和非COVID-19）的影响。
方法
我们检索了EMBASE、Cochrane系统评价数据库、MEDLINE、护理学与健康相关文献累积索引（CINAHL）以及Cochrane对照试验注册库（CENTRAL），检索时间从起始（1948年）至2020年12月31日。我们采用两阶段审查流程来筛选/提取数据。我们使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。我们采用推荐意见的严格评价与评估、制定和评价（GRADE）方法。
结果
在11581条文献中，194项研究符合纳入标准。在这些研究中，31项有死亡率比较（n = 433196345名参与者）。与大流行前相比，在COVID-19大流行期间，我们的荟萃分析表明，COVID-19死亡率的风险差异（RD）增加了0.06%（95%CI：0.06 - 0.06%，P < 0.00001）。全因死亡率也有所增加[相对风险（RR）：1.53，95%置信区间（CI）：1.38 - 1.70，P < 0.00001]，非COVID-19死亡率也增加了（RR：1.18，1.07 - 1.30，P < 0.00001）。通过GRADE评估，所有研究结果的证据确定性为“非常低”，表明证据不确定。
解读
COVID-19大流行可能导致全因超额死亡率显著增加，高于仅由COVID-19死亡率增加所导致的水平，尽管证据不确定。
系统评价注册
[https://www.crd.york.ac.uk/prospero/#recordDetails]，标识符[CRD42020201256]
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