丹麦和瑞典儿童癌症幸存者中的新冠病毒感染情况及严重程度：一项基于登记册的队列研究，包括匹配人群和同胞对照。
COVID-19 infection and severity among childhood cancer survivors in Denmark and Sweden: a register-based cohort study with matched population and sibling comparisons.
作者信息
Louro Javier, Kampitsi Christina-Evmorfia, Mogensen Hanna, Erdmann Friederike, Modig Karin, Nilsson Anna, Heyman Mats, Hasle Henrik, Krøyer Anja, Kenborg Line, Hjalgrim Henrik, Feychting Maria, Tettamanti Giorgio
机构信息
Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden.
出版信息
Lancet Reg Health Eur. 2025 Jul 4;55:101363. doi: 10.1016/j.lanepe.2025.101363. eCollection 2025 Aug.
BACKGROUND
During the COVID-19 pandemic, vulnerable groups faced a higher risk of severe COVID-19 outcomes. The effect of the pandemic on adult childhood cancer survivors is a significant public health concern but not sufficiently understood. We aimed to assess whether adult childhood cancer survivors had a higher risk of severe COVID-19 and registered COVID-19 infections compared to the general population.
METHODS
This Nordic register-based cohort study included 5-year childhood cancer survivors diagnosed before age 20 years in Denmark and Sweden, two countries with very different pandemic responses. As comparisons, we randomly selected individuals from the general population, matched on year of birth, sex, and country, and identified all siblings of the survivors. All individuals at least 20 years old and alive on January 1, 2020, were followed until December 31, 2022. We plotted the cumulative hazard rates of severe COVID-19 and registered COVID-19 infection and fitted Cox proportional hazards models estimating adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI).
FINDINGS
The cohort included 13,659 cancer survivors, 58,803 matched comparisons, and 17,531 siblings. Childhood cancer survivors had a lower risk of registered COVID-19 infection (aHR = 0·91; 95% CI = 0·89-0·94) compared to their comparisons but a higher risk of severe COVID-19 (aHR = 1·58; 95% CI = 1·25-1·98). The latter was particularly evident during periods of widespread viral transmission, as reflected in differences between Denmark and Sweden.
INTERPRETATION
These findings underscore the heightened vulnerability of childhood cancer survivors, even many years after their cancer diagnosis, and emphasize the need for closer monitoring and tailored interventions to safeguard this population during future health crises.
FUNDING
Danish and Swedish Childhood Cancer Foundation, Danish National Research Centre for Childhood Cancer, Swedish Research Council, and NordForsk.
背景
在新冠疫情期间，弱势群体面临着更高的新冠重症风险。疫情对成年期儿童癌症幸存者的影响是一个重大的公共卫生问题，但尚未得到充分了解。我们旨在评估成年期儿童癌症幸存者与普通人群相比，是否有更高的新冠重症和确诊感染风险。
方法
这项基于北欧登记处的队列研究纳入了丹麦和瑞典20岁前被诊断为儿童癌症的5年幸存者，这两个国家的疫情应对措施差异很大。作为对照，我们从普通人群中随机选取了出生年份、性别和国家相匹配的个体，并确定了幸存者的所有兄弟姐妹。所有在2020年1月1日至少20岁且存活的个体均被随访至2022年12月31日。我们绘制了新冠重症和确诊感染的累积风险率，并拟合了Cox比例风险模型，以估计调整后的风险比（aHR）及95%置信区间（95%CI）。
结果
该队列包括13659名癌症幸存者、58803名匹配对照和17531名兄弟姐妹。与对照相比，儿童癌症幸存者确诊感染新冠的风险较低（aHR = 0.91；95%CI = 0.89 - 0.94），但新冠重症风险较高（aHR = 1.58；95%CI = 1.25 - 1.98）。后者在病毒广泛传播期间尤为明显，丹麦和瑞典之间的差异就反映了这一点。
解读
这些发现强调了儿童癌症幸存者即使在癌症诊断多年后仍存在更高的脆弱性，并强调在未来的健康危机期间需要进行更密切的监测和针对性干预，以保护这一人群。
资金来源
丹麦和瑞典儿童癌症基金会、丹麦国家儿童癌症研究中心、瑞典研究理事会和北欧研究委员会。
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