Changhua County Public Health Bureau, Changhua, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Infect Public Health. 2024 May;17(5):735-740. doi: 10.1016/j.jiph.2024.03.006. Epub 2024 Mar 6.
The trajectories of all-cause deaths linked to omicron infections are rarely studied, especially in relation to the efficacy of booster shots. For assessing three epidemiological death trajectories, including dying from COVID-19, dying with COVID-19, and non-COVID-19 death, we offer a new COVID-19-and-death competing risk model that deals with the primary pathway (e.g., dying from COVID-19) competing with two other pathways.
We applied this model to track three trajectories: deaths directly from COVID-19, deaths with COVID-19 as a contributing factor, and indirect non-COVID-19 deaths. The study used data from a Taiwanese cohort, covering periods of Omicron subvariants BA.2, BA.5, and BA.2.75. It focused on the effectiveness of monovalent and bivalent booster vaccines against these death trajectories.
The highest mortality was observed during the BA.2 phase, which decreased in the BA.5 period and increased again in the BA.2.75 period. Analyzing each trajectory, we noted similar trends in deaths directly from and with COVID-19, while non-COVID-19 deaths remained stable across subvariants. Booster vaccines reduced all-cause mortality by 58% (52%-62%) for BA.2, 70% (65%-75%) for BA.5%, and 75% (70%-80%) for BA.2.75, compared to incomplete vaccination. The reduction in deaths directly from COVID-19 was 66% (61%-72%) for BA.2, 78% (72%-84%) for BA.5%, and 85% (76%-93%) for BA.2.75. For deaths with COVID-19, the figures were 46% (36%-55%), 76% (68%-84%), and 90% (86%-95%). Additionally, the booster shots decreased non-COVID-19 deaths by 64% (63%-66%) for BA.2, 38% (36%-40%) for BA.5, and 19% (17%-21%) for BA.2.75.
Our competing risk analysis is effective for monitoring all-cause death trajectories amidst various Omicron infections. It provides insights into the impact of booster vaccines, especially bivalent ones, and highlights the consequences of inadequate healthcare for vulnerable groups.
与奥密克戎感染相关的全因死亡轨迹很少被研究，尤其是在加强针的疗效方面。为了评估包括死于 COVID-19、COVID-19 相关死亡和非 COVID-19 死亡在内的三种流行病学死亡轨迹，我们提供了一种新的 COVID-19 和死亡竞争风险模型，该模型可处理主要途径（例如死于 COVID-19）与其他两种途径的竞争。
我们将该模型应用于跟踪三种轨迹：直接死于 COVID-19 的死亡、COVID-19 作为促成因素的死亡和间接非 COVID-19 死亡。该研究使用了来自台湾队列的数据，涵盖了奥密克戎亚变体 BA.2、BA.5 和 BA.2.75 的时期。它侧重于单价和 bivalent 加强疫苗对这些死亡轨迹的有效性。
在 BA.2 阶段观察到最高的死亡率，在 BA.5 期间降低，在 BA.2.75 期间再次增加。分析每条轨迹，我们注意到直接死于 COVID-19 和 COVID-19 相关死亡的趋势相似，而非 COVID-19 死亡在亚变体之间保持稳定。与不完全接种疫苗相比，加强疫苗可使 BA.2 的全因死亡率降低 58%（52%-62%），BA.5 的全因死亡率降低 70%（65%-75%），BA.2.75 的全因死亡率降低 75%（70%-80%）。BA.2 直接死于 COVID-19 的死亡率降低了 66%（61%-72%），BA.5 降低了 78%（72%-84%），BA.2.75 降低了 85%（76%-93%）。对于 COVID-19 相关死亡，其数据分别为 46%（36%-55%）、76%（68%-84%）和 90%（86%-95%）。此外，加强疫苗还降低了 BA.2 的非 COVID-19 死亡率 64%（63%-66%）、BA.5 的 38%（36%-40%）和 BA.2.75 的 19%（17%-21%）。
我们的竞争风险分析对于监测各种奥密克戎感染中的全因死亡轨迹是有效的。它提供了加强针，特别是 bivalent 加强针的影响的见解，并强调了弱势群体获得适当医疗保健的后果。
