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基层医疗保健登记与 COVID-19 死亡率:2020-2021 年巴西里约热内卢五个行政区的糖尿病患者队列研究。

Registration with Primary Health Care and COVID-19 mortality: cohort of diabetics from five administrative health regions in the city of Rio de Janeiro, Brazil, 2020-2021.

机构信息

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva - Rio de Janeiro (RJ), Brasil.

Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil.

出版信息

Rev Bras Epidemiol. 2023 Sep 18;26:e230039. doi: 10.1590/1980-549720230039.2. eCollection 2023.

Abstract

OBJECTIVE

The present study carried out an analysis of survival according to the status of registration with Primary Health Care (PHC) and of factors associated with death from COVID-19, in cases residing in Programmatic Area 3.1 (PA3.1) with a diagnosis of diabetes (in the notification form or in the electronic medical record), of the Municipality of Rio de Janeiro (RJ), Brazil, in 2020-2021.

METHODS

A probabilistic linkage of databases was performed based on information on cases notified as COVID-19 and data from the electronic medical records of people living with diabetes. A survival analysis was carried out, using the Cox regression model stratified by age group and adjusted for confounding variables.

RESULTS

Individuals registered with the PHC of PA3.1 had almost twice the risk of death from COVID-19 (adjusted hazard ratio [HRadj]=1.91) when compared to those unregistered. This association was stronger in individuals aged 18 to 59 years registered with the PHC (HRadj=2.82) than in individuals aged 60 years or over (HRadj=1.56).

CONCLUSION

Surveillance strategies for identifying and adequately monitoring higher-risk groups, among individuals living with diabetes, within the scope of Primary Health Care, can contribute to reducing mortality from COVID-19.

摘要

目的

本研究对巴西里约热内卢市(RJ)2020-2021 年 Programmatic Area 3.1(PA3.1)居住、患有糖尿病(在通知表或电子病历中)且在初级卫生保健(PHC)登记状态与 COVID-19 死亡相关因素的生存情况进行分析。

方法

对确诊为 COVID-19 的病例和糖尿病患者电子病历数据进行基于概率的数据库链接,采用 Cox 回归模型进行生存分析,并按年龄组分层调整混杂因素。

结果

与未登记者相比,PA3.1 的 PHC 登记者因 COVID-19 死亡的风险几乎高出一倍(调整后的危险比[HRadj]=1.91)。在年龄在 18 至 59 岁之间登记的 PHC 者中,该关联更强(HRadj=2.82),而在 60 岁及以上者中较弱(HRadj=1.56)。

结论

初级卫生保健范围内,针对糖尿病患者中较高风险人群进行识别和充分监测的监测策略,有助于降低 COVID-19 死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5202/10548836/c66ed081dfb9/1980-5497-rbepid-26-e230039-gf03.jpg

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