Qulturum Development Department, Region Jönköping County, Jönköping, Sweden.
Region Jönköping County, Division of Surgical Care, Jönköping, Sweden.
BMC Infect Dis. 2023 Mar 14;23(1):156. doi: 10.1186/s12879-023-08115-0.
In preparation of future pandemics, it is important to recognise population-level determinants associated with development of severe illness before efficient vaccines and evidence-based therapeutic measures are available. The aim of this study was to identify pre-pandemic diagnoses recorded in a middle-aged and elderly population that were associated with development of severe COVID-19 during the first pandemic year.
A cohort study design was used. Severe COVID-19 was defined as a course of illness that resulted in hospital admission or death. A retrospective analysis was performed that comprised all individuals aged 39 years and older (N = 189,951) living in Jönköping County, Sweden. All diagnosed morbidity recorded in contacts with health care during the pre-pandemic year 2019 was used to identify which diagnoses that were associated with development of severe COVID-19 in the first pandemic year 2020. The analyses were performed separately for each diagnosis using binary logistic regression with adjustment for sex and age.
Severe COVID-19 was suffered by 0.67% (N = 1,280) of the middle-aged and elderly population in the first pandemic year. Individuals previously diagnosed with dementia, cerebral palsy, kidney failure, type 2 diabetes mellitus, hypertension, and obesity were at higher risk of developing severe COVID-19. For patients with Type 2 diabetes mellitus, the odds ratio (OR) was 2.18 (95% confidence interval, 1.92-2.48). Type 1 diabetes mellitus was not associated with increased risk.
Diagnoses suggesting service provision at long-term healthcare facilities and co-morbidity with components of the metabolic syndrome were associated with an increased risk of developing severe COVID-19 in a middle-aged and elderly population before vaccines were available.
为应对未来的大流行，在有效疫苗和基于证据的治疗措施问世之前，识别与严重疾病发生相关的人群水平决定因素非常重要。本研究旨在确定在大流行的第一年，中年和老年人中记录的大流行前诊断与 COVID-19 严重程度发展相关。
采用队列研究设计。严重 COVID-19 的定义为导致住院或死亡的疾病过程。对所有年龄在 39 岁及以上（N=189951）居住在瑞典延雪平省的个体进行回顾性分析。使用 2019 年大流行前一年与医疗保健接触中记录的所有诊断性发病情况，确定哪些诊断与 2020 年大流行的第一年发生严重 COVID-19 相关。使用二元逻辑回归分别对每种诊断进行分析，调整性别和年龄。
在大流行的第一年，中年和老年人群中，有 0.67%（N=1280）患有严重 COVID-19。以前被诊断为痴呆、脑瘫、肾衰竭、2 型糖尿病、高血压和肥胖症的个体发生严重 COVID-19 的风险更高。对于 2 型糖尿病患者，比值比（OR）为 2.18（95%置信区间，1.92-2.48）。1 型糖尿病与增加的风险无关。
在疫苗可用之前，提示需要在长期医疗保健机构提供服务的诊断以及与代谢综合征成分的合并症与中年和老年人发生严重 COVID-19 的风险增加相关。
