Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy.
Azienda Zero, Padova, Italy.
Front Public Health. 2023 Oct 4;11:1241401. doi: 10.3389/fpubh.2023.1241401. eCollection 2023.
Knowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations.
The present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU's Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis.
There were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications.
The outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial percentage of cases, even among a previously healthy population with low or mild severity of acute COVID-19. The study results provide useful insights into planning COVID-19-related services.
随着时间的推移，人们对 SARS-CoV-2 传播动力学和 COVID-19 临床方面的认识不断提高，但对疾病严重程度和持续时间的决定因素的证据仍然有限，主要集中在老年和脆弱人群。
本研究是在意大利艾米利亚-罗马涅（Emilia-Romagna，E-R）和威尼托（Veneto）地区开展的，属于欧盟 Horizon 2020 研究项目“ORCHESTRA（连接欧洲队列以增强对 SARS-CoV-2 大流行的共同和有效应对）”的一部分（www.orchestra-cohort.eu）。该研究采用多中心回顾性基于人群的队列设计，旨在调查在 SARS-CoV-2 感染后第 31 天至第 365 天的急性后阶段，低危严重急性 COVID-19 人群中，特定医疗服务（门诊就诊和诊断、药物处方）的就诊率及相关风险因素。研究利用了意大利两个地区行政数据库中先前记录的大规模医疗保健数据。采用竞争风险分析方法进行统计学分析。在两个地区分别评估风险因素，并使用随机效应荟萃分析对结果进行合并。
E-R 地区有 35128 名受试者，威尼托地区有 88881 名受试者纳入数据分析。在急性后阶段，高比例的受试者发生了结局（选择的医疗服务就诊）（E-R 地区为 25%，威尼托地区为 21%）。与药物处方相比，门诊就诊更为常见（E-R 地区为 18%，威尼托地区为 15%；E-R 地区为 12%，威尼托地区为 10%）。与结局相关的风险因素包括女性、年龄大于 40 岁、基线住院和死亡风险、中重度急性 COVID-19 以及急性肺外并发症。
所关注的结局可以被视为 COVID-19 长期影响需要临床关注的替代指标。我们的数据表明，即使在急性 COVID-19 严重程度低或轻度的既往健康人群中，这种结局也在很大比例的病例中发生。研究结果为规划 COVID-19 相关服务提供了有用的信息。
