PISCIS队列中感染人类免疫缺陷病毒的移民在2019冠状病毒病临床结局和疫苗接种覆盖率方面的差异：一项基于人群的倾向评分匹配分析
Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis.
作者信息
Nomah Daniel K, Díaz Yesika, Bruguera Andreu, Moreno-Fornés Sergio, Aceiton Jordi, Reyes-Urueña Juliana, Llibre Josep M, Falcó Vicenç, Imaz Arkaitz, Fanjul Francisco Javier, Peraire Joaquim, Deig Elisabet, Domingo Pere, Inciarte Alexy, Casabona Jordi, Miró José M
机构信息
Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain.
Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain.
出版信息
Open Forum Infect Dis. 2024 Jan 5;11(1):ofad693. doi: 10.1093/ofid/ofad693. eCollection 2024 Jan.
BACKGROUND
Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors.
METHODS
Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression.
RESULTS
The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, < .0001) and booster doses (63.0% vs 65.5%, = .027). COVID-19 hospitalizations (8.1% vs 5.1%, < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, = .098) and mortality (3 [0.2%] vs 6 [0.4%], = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants.
CONCLUSIONS
MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.
背景
2019年冠状病毒病（COVID-19）对移民和少数族裔的影响尤为严重，包括那些感染人类免疫缺陷病毒（HIV）的人群。需要进行全面研究以了解其影响和风险因素。
方法
利用西班牙加泰罗尼亚地区HIV感染者（PWH）的PISCIS队列数据，我们调查了COVID-19的结局和疫苗接种覆盖率。在10640名PWH中，我们通过倾向得分匹配和多变量Cox回归比较了移民和非移民，评估严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测率、诊断率及相关临床结局。
结果
该队列（平均年龄43岁；83.5%为男性）包括57.4%（3053人）的拉丁美洲移民。与西班牙本地人相比，感染HIV的移民（MWH）的SARS-CoV-2检测次数较少（67.8%对72.1%，P<0.0001），但COVID-19诊断率相似（29.2%对29.4%，P = 0.847）。移民的全程疫苗接种率较低（78.9%对85.1%，P<0.0001），加强针接种率也较低（63.0%对65.5%，P = 0.027）。移民中的COVID-19住院率（8.1%对5.1%，P<0.0001）和重症监护病房（ICU）收治率（2.9%对1.2%，P<0.0001）较高，住院时间相似（5.5天对4.0天，P = 0.098），死亡率也相似（3例[0.2%]对6例[0.4%]，P = 0.510）。年龄≥40岁、CD4细胞计数<200个/μL、合并症≥2种以及未完成/未接种SARS-CoV-2疫苗会增加移民中发生重症COVID-19的风险。
结论
MWH的SARS-CoV-2检测率和疫苗接种覆盖率较低，尽管移民和非移民的COVID-19诊断率相似。与非移民相比，移民中COVID-19相关的住院率和ICU收治率较高，住院时间和死亡率相似。这些发现可为制定政策以解决未来大流行应对中MWH的差异提供参考。
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