哥斯达黎加新冠肺炎导致的超额死亡率：一项基于登记处数据、使用泊松回归的研究
Excess mortality from COVID 19 in Costa Rica: a registry based study using Poisson regression.
作者信息
Fantin Romain, Barboza-Solís Cristina, Hildesheim Allan, Herrero Rolando
机构信息
Centro Centroamericano de Población, Universidad de Costa Rica, San Pedro, Costa Rica.
Agencia Costarricense de Investigaciones Biomédicas - Fundación Inciensa, San José, Costa Rica.
出版信息
Lancet Reg Health Am. 2023 Apr;20:100451. doi: 10.1016/j.lana.2023.100451. Epub 2023 Feb 22.
BACKGROUND
Official death toll related to COVID-19 has been considerably underestimated in reports from some Latin American countries. This study aimed to analyze the mortality associated with the COVID-19 pandemic in Costa Rica between March 2020 and December 2021.
METHODS
A registry based study based on 2017-2021 data from the National Institute of Statistics and Census was designed (N = 128,106). Excess deaths were defined by the WHO as ; and were estimated using a Poisson regression, and mortality and years of potential life lost (YPLL) rates were calculated.
FINDINGS
The COVID-19 pandemic represented 15% of the deaths in Costa Rica between March 2020 and December 2021. The mortality rate related to COVID-19 was 83 per 100,000 person-years. Between March and July 2020 (low-incidence period), observed number of deaths was 9%-lower than expected, whereas it was 15% and 24% higher than expected between July 2020 and March 2021 (high incidence period - no vaccination), and between March 2021 and December 2021 (high incidence period - progressive vaccination) respectively. Between July 2020 and December 2021, excess deaths observed and COVID-19 deaths reported were comparable (7461 and 7620 respectively). Nevertheless, there were more deaths than expected for conditions that predispose to COVID-19 deaths. YPLL and mortality rates increased with age, but significant excess deaths were observed in all age-groups older than 30-39 years. No large differences were noted by districts' socioeconomic characteristics although excess death rate was lower in rural compared to urban areas.
INTERPRETATION
Reporting of deaths was only slightly underestimated. In the pre-vaccination period, mortality rate and YPLL rates increased with age, being highest in people aged 60 years or older and justifying the decision to initially prioritize vaccination of older individuals.
FUNDING
The study was supported by the University of Costa Rica and the Agencia Costarricense de Investigaciones Biomédicas - Fundación Inciensa.
背景
一些拉丁美洲国家的报告中，与新冠病毒病（COVID-19）相关的官方死亡人数被大幅低估。本研究旨在分析2020年3月至2021年12月期间哥斯达黎加与COVID-19大流行相关的死亡率。
方法
设计了一项基于登记的研究，数据来源于国家统计和普查研究所2017 - 2021年的数据（N = 128,106）。世界卫生组织将超额死亡定义为……；使用泊松回归进行估计，并计算死亡率和潜在寿命损失年数（YPLL）率。
研究结果
2020年3月至2021年12月期间，COVID-19大流行导致的死亡占哥斯达黎加死亡总数的15%。与COVID-19相关的死亡率为每10万人年83例。在2020年3月至7月（低发期），观察到的死亡人数比预期低9%，而在2020年7月至2021年3月（高发期 - 未接种疫苗）以及2021年3月至2021年12月（高发期 - 逐步接种疫苗）期间，分别比预期高15%和24%。在2020年7月至2021年12月期间，观察到的超额死亡人数与报告的COVID-19死亡人数相当（分别为7461例和7620例）。然而，易导致COVID-19死亡的疾病导致的死亡人数超过预期。YPLL和死亡率随年龄增长而增加，但在所有30 - 39岁以上的年龄组中均观察到显著的超额死亡。尽管农村地区的超额死亡率低于城市地区，但按地区的社会经济特征未发现大的差异。
解读
死亡报告仅被略微低估。在疫苗接种前时期，死亡率和YPLL率随年龄增长而增加，在60岁及以上人群中最高，这证明了最初优先为老年人接种疫苗的决定是合理的。
资金来源
本研究由哥斯达黎加大学和哥斯达黎加生物医学研究机构 - 因森萨基金会资助。
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