Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy.
BMJ Open. 2023 Oct 29;13(10):e073471. doi: 10.1136/bmjopen-2023-073471.
We aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic period (2020-2021).
Population-based retrospective study.
SETTING/PARTICIPANTS: Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%).
COVID-19 incidence among chronic disease patients was 4.1% (74 067 cases) in 2020 and 7.3% (126 556 cases) in 2021, varying across pathologies, with obesity and dementia showing the highest incidence. Hospitalisation rate for pneumonia or acute respiratory distress syndrome among SARS-CoV-2-positive patients was 15.4%. COVID-19-related excess mortality, that is, deaths from COVID-19 as either main or contributing (1.5% of the total) cause of death, was observed during the three pandemic waves, with observed/expected death ratios ranging from +38% (March 2020) to +11% (December 2021). Increased risks of both COVID-19-related hospitalisation and death were associated with male gender, elderly age and many pre-existing pathologies, including cardiovascular, cerebrovascular and respiratory diseases, neurological and psychiatric disorders, and metabolic dysfunctions. The higher the number of concomitant pathologies, the greater the risk of COVID-19-related adverse outcomes: the likelihood of hospitalisation and death more than doubled for people with more than two comorbidities, compared with those with one underlying condition.
This study presents a thorough and up-to-date quantification of the direct impact of COVID-19 on chronic disease patients. The results obtained are particularly relevant considering that people with pre-existing chronic conditions accounted for almost all cases of COVID-19-related hospitalisation (82.6%) and death (91.5%) in a vast region of Italy, among the hardest hit by the pandemic.
我们旨在提供一个全地区范围内的综合报告，阐述在 COVID-19 大流行的 2 年期间（2020-2021 年），直接影响慢性疾病患者的疾病发病率、严重程度和死亡率的相关因素。
基于人群的回顾性研究。
地点/参与者：意大利艾米利亚-罗马涅地区的成年患者，患有 32 种常见慢性病中的至少 1 种，2020 年（n=1791189，占全地区成年人口的 47.7%）和 2021 年（n=1801071，占全地区成年人口的 47.8%）。
2020 年和 2021 年，慢性疾病患者的 COVID-19 发病率分别为 4.1%（74067 例）和 7.3%（126556 例），不同病理变化的发病率有所不同，肥胖和痴呆症的发病率最高。SARS-CoV-2 阳性患者中肺炎或急性呼吸窘迫综合征的住院率为 15.4%。在三次大流行浪潮中，观察到 COVID-19 相关超额死亡率，即 COVID-19 导致的死亡（占总死亡人数的 1.5%）作为主要或次要（1.5%）死因，观察到的/预期的死亡比例从 3 月的+38%（2020 年）到 12 月的+11%（2021 年）。COVID-19 相关住院和死亡的风险均与男性、老年和许多先前存在的疾病（包括心血管、脑血管和呼吸系统疾病、神经和精神障碍以及代谢功能障碍）相关。同时患有多种疾病的患者，其 COVID-19 相关不良结局的风险更高：与仅患有一种基础疾病的患者相比，同时患有两种以上合并症的患者住院和死亡的可能性增加了一倍以上。
本研究全面、及时地量化了 COVID-19 对慢性疾病患者的直接影响。鉴于意大利艾米利亚-罗马涅地区绝大多数 COVID-19 相关住院病例（82.6%）和死亡病例（91.5%）都是由患有慢性疾病的人群引起，因此，该研究结果尤其具有现实意义。该地区是意大利受大流行影响最严重的地区之一。
