Ioannidis John P A
Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Rd, Medical School Office Building, Room X306, Stanford, CA, 94305, USA.
Eur J Epidemiol. 2024 Nov;39(11):1211-1219. doi: 10.1007/s10654-024-01169-7. Epub 2024 Nov 20.
Healthcare workers may have different risk for severe outcomes compared with the general population during diverse crises. This paper introduces the concept of healthcare worker versus population hazard (HPH), the risk of an outcome of interest in active healthcare workers compared with the general population they serve. HPH can be expressed with relative risk (HPH(r)) and absolute risk difference (HPH(a)) metrics. Illustrative examples are drawn from infectious outbreaks, war, and the COVID-19 pandemic on death outcomes. HPH can be extreme for lethal outbreaks (HPH(r) = 30 to 143, HPH(a) = 8 to 91 per 1000 for Ebola deaths in 3 Western African countries in 2013-5), and modestly high in relative terms and very high in absolute terms for protracted, major armed conflicts (HPH(r) = 1.38 and HPH(a) = 10.2 for Syria during 2011-2024). Conversely, healthcare workers had 8-12-fold lower risk than the population they served for pandemic excess deaths (physicians in USA) or COVID-19 deaths (physicians in Ontario, healthcare workers in Finland), while healthcare workers in Indonesia did not have this advantage for COVID-19 deaths versus the general population. HPH is susceptible to data inaccuracies in numbers of at-risk populations and of outcomes of interest. Importantly, inferences about healthcare worker risk can be misleading, if deaths of retired healthcare workers contaminate the risk calculations- as in the case of misleading early perceptions of exaggerated COVID-19 risk for healthcare professionals. HPH can offer useful insights for risk assessment to healthcare professionals, the general public, and policy makers and may be useful to monitor for planning and interventions during crises.
在不同危机期间，医护人员与普通人群相比，可能面临不同的严重后果风险。本文介绍了医护人员与人群危害（HPH）的概念，即在职医护人员与他们所服务的普通人群相比，发生感兴趣结局的风险。HPH可以用相对风险（HPH(r)）和绝对风险差异（HPH(a)）指标来表示。文中从传染病爆发、战争和新冠疫情导致的死亡结局中选取了示例进行说明。对于致命性疫情，HPH可能极为显著（2013 - 2015年在3个西非国家，埃博拉死亡的HPH(r) = 30至143，HPH(a) =每1000人中有8至91人）；对于长期的重大武装冲突，相对而言HPH处于中等偏高水平，绝对风险则非常高（2011 - 2024年叙利亚的HPH(r) = 1.38，HPH(a) = 10.2）。相反，对于大流行期间的超额死亡（美国的医生）或新冠死亡（安大略省的医生、芬兰的医护人员），医护人员的风险比他们所服务的人群低8至12倍，而印度尼西亚的医护人员在新冠死亡方面相对于普通人群则没有这种优势。HPH容易受到高危人群数量和感兴趣结局数据不准确的影响。重要的是，如果退休医护人员的死亡影响了风险计算，那么关于医护人员风险的推断可能会产生误导——就像早期对医护人员夸大的新冠风险的错误认知那样。HPH可以为医护人员、公众和政策制定者提供有用的风险评估见解，并且可能有助于在危机期间进行规划和干预的监测。
