Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA; Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA; Division of Pharmacoepidemiology, Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA.
Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA; Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA.
Lancet Infect Dis. 2024 Mar;24(3):239-255. doi: 10.1016/S1473-3099(23)00684-9. Epub 2023 Dec 14.
Previous comparative analyses of people admitted to hospital for COVID-19 versus influenza evaluated the risk of death, hospital readmission, and a narrow set of health outcomes up to 6 months following infection. We aimed to do a comparative evaluation of both acute and long-term risks and burdens of a comprehensive set of health outcomes following hospital admission for COVID-19 or seasonal influenza.
For this cohort study we used the health-care databases of the US Department of Veterans Affairs to analyse data from 81 280 participants admitted to hospital for COVID-19 between March 1, 2020, and June 30, 2022, and 10 985 participants admitted to hospital for seasonal influenza between Oct 1, 2015, and Feb 28, 2019. Participants were followed up for up to 18 months to comparatively evaluate risks and burdens of death, a prespecified set of 94 individual health outcomes, ten organ systems, overall burden across all organ systems, readmission, and admission to intensive care. Inverse probability weighting was used to balance the baseline characteristics. Cox and Poisson models were used to generate estimates of risk on both the relative scale and absolute scale as the event rate and disability-adjusted life-years (DALYs) per 100 persons.
Over 18 months of follow-up, compared to seasonal influenza, the COVID-19 group had an increased risk of death (hazard ratio [HR] 1·51 [95% CI 1·45-1·58]), corresponding to an excess death rate of 8·62 (95% CI 7·55-9·44) per 100 persons in the COVID-19 group versus the influenza group. Comparative analyses of 94 prespecified health outcomes showed that COVID-19 had an increased risk of 68·1% (64 of 94) pre-specified health outcomes; seasonal influenza was associated with an increased risk of 6·4% (six of 94) pre-specified health outcomes, including three out of four pre-specified pulmonary outcomes. Analyses of organ systems showed that COVID-19 had a higher risk across all organ systems except for the pulmonary system, the risk of which was higher in seasonal influenza. The cumulative rates of adverse health outcomes across all organ systems were 615·18 (95% CI 605·17-624·88) per 100 persons in COVID-19 and 536·90 (527·38-544·90) per 100 persons in seasonal influenza, corresponding to an excess rate of 78·72 (95% CI 66·15-91·24) per 100 persons in COVID-19. The total number of DALYs across all organ systems were 287·43 (95% CI 281·10-293·59) per 100 persons in the COVID-19 group and 242·66 (236·75, 247·67) per 100 persons in the seasonal influenza group, corresponding to 45·03 (95% CI 37·15-52·90) higher DALYs per 100 persons in COVID-19. Decomposition analyses showed that in both COVID-19 and seasonal influenza, there was a higher burden of health loss in the post-acute than the acute phase; and comparatively, except for the pulmonary system, COVID-19 had a higher burden of health loss across all other organ systems than seasonal influenza in both the acute and post-acute phase. Compared to seasonal influenza, COVID-19 also had an increased risk of hospital readmission (excess rate 20·50 [95% CI 16·10-24·86] per 100 persons) and admission to intensive care (excess rate 9·23 [6·68-11·82] per 100 persons). The findings were consistent in analyses comparatively evaluating risks in seasonal influenza versus COVID-19 by individuals' respective vaccination status and in those admitted to hospital during the pre-delta, delta, and omicron eras.
Although rates of death and adverse health outcomes following hospital admission for either seasonal influenza or COVID-19 are high, this comparative analysis shows that hospital admission for COVID-19 was associated with higher long-term risks of death and adverse health outcomes in nearly every organ system (except for the pulmonary system) and significant cumulative excess DALYs than hospital admission for seasonal influenza. The substantial cumulative burden of health loss in both groups calls for greater prevention of hospital admission for these two viruses and for greater attention to the care needs of people with long-term health effects due to either seasonal influenza or SARS-CoV-2 infection.
US Department of Veterans Affairs.
先前对因 COVID-19 和流感住院的患者进行的比较分析评估了感染后 6 个月内死亡、再次住院和一系列健康结果的风险。本研究旨在针对 COVID-19 或季节性流感住院后一系列广泛的健康结果，比较评估急性期和长期风险及负担。
本队列研究利用美国退伍军人事务部的医疗保健数据库，分析了 2020 年 3 月 1 日至 2022 年 6 月 30 日期间因 COVID-19 住院的 81280 名患者和 2015 年 10 月 1 日至 2019 年 2 月 28 日期间因季节性流感住院的 10985 名患者的数据。患者随访时间最长达 18 个月，比较评估两组患者的死亡风险、预先设定的 94 个单一健康结果、10 个器官系统、所有器官系统的总负担、再次住院和入住重症监护病房的风险。使用逆概率加权法平衡基线特征。Cox 比例风险模型和泊松回归模型用于生成风险的相对和绝对估计值，即事件发生率和每 100 人残疾调整生命年（disability-adjusted life-years，DALYs）。
在 18 个月的随访期间，与季节性流感相比，COVID-19 组的死亡风险更高（风险比[hazard ratio，HR] 1.51[95%置信区间 1.45-1.58]），相应的 COVID-19 组比流感组每 100 人死亡人数多 8.62（95%置信区间 7.55-9.44）。对 94 项预先设定的健康结果的比较分析显示，COVID-19 导致 68.1%（94 项中的 64 项）预先设定的健康结果风险增加；而季节性流感与 6.4%（94 项中的 6 项）预先设定的健康结果风险增加，其中包括 4 项预先设定的肺部结果中的 3 项。对所有器官系统的分析表明，COVID-19 的风险高于所有器官系统，除了肺部系统，而肺部系统的风险在季节性流感中更高。所有器官系统累积不良健康结果发生率为 COVID-19 组 615.18（95%置信区间 605.17-624.88）/100 人，季节性流感组 536.90（527.38-544.90）/100 人，COVID-19 组比季节性流感组多 78.72（95%置信区间 66.15-91.24）/100 人。所有器官系统的总 DALYs 为 COVID-19 组 287.43（95%置信区间 281.10-293.59）/100 人，季节性流感组 242.66（236.75，247.67）/100 人，COVID-19 组比季节性流感组多 45.03（95%置信区间 37.15-52.90）/100 人。分解分析显示，在 COVID-19 和季节性流感中，急性后阶段的健康损失负担均高于急性期；且除了肺部系统外，COVID-19 在急性期和急性后阶段对所有其他器官系统的健康损失负担均高于季节性流感。与季节性流感相比，COVID-19 再次住院（超额率 20.50[95%置信区间 16.10-24.86]/100 人）和入住重症监护病房（超额率 9.23[6.68-11.82]/100 人）的风险也更高。按各自的疫苗接种状况和按 delta 前、delta 期间和 omicron 期间入院的患者比较评估季节性流感和 COVID-19 的风险，分析结果一致。
尽管因季节性流感或 COVID-19 住院的患者死亡和不良健康结果的发生率较高，但本比较分析表明，与季节性流感相比，COVID-19 与更高的长期死亡和几乎所有器官系统（肺部系统除外）不良健康结果风险相关，且累积的显著超额 DALYs 也高于季节性流感。两组患者的健康损失累积负担巨大，这呼吁我们更加重视预防这两种病毒引起的住院，更加关注因季节性流感或 SARS-CoV-2 感染而长期健康受影响的人群的护理需求。
美国退伍军人事务部。
