Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study.
Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study.
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COVID-19和季节性流感的特征、发病率和死亡率的比较：一项全国性、基于人群的回顾性队列研究。
DOI：
10.1016/s2213-2600(20)30527-0
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Quantin C
中科院分区：
文献类型：
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作者：
Piroth L;Cottenet J;Mariet AS;Bonniaud P;Blot M;Tubert-Bitter P;Quantin C
迄今为止，流感流行被认为适合用作COVID-19流行的模型，因为它们是具有相似传播模式的呼吸道疾病。然而，直接比较这两种疾病的数据很少。我们使用法国国家行政数据库（PMSI）进行了一项全国性的回顾性队列研究，其中包括法国所有住院患者的出院摘要。纳入了2020年3月1日至4月30日因COVID-19住院的所有患者，以及2018年12月1日至2019年2月28日因流感住院的所有患者。COVID-19（国际疾病分类[第10版]代码U07.10、U07.11、U07.12、U07.14或U07.15）或流感（J 09、J10或J11）的诊断包括主要、相关或相关诊断。对因COVID-19和流感住院的患者的风险因素、临床特征和结局进行了比较，数据也按年龄组分层。在各自的研究期间，89530名COVID-19患者和45819名流感患者在法国住院。 COVID-19患者的中位年龄为68岁（IQR 52-82），流感患者的中位年龄为71岁（34-84）。与流感患者相比，COVID-19患者更常肥胖或超重，更常患有糖尿病、高血压和血脂异常，而流感患者更常患有心力衰竭、慢性呼吸道疾病、肝硬化和缺乏性贫血。与流感患者相比，因COVID-19入院的患者更容易发生急性呼吸衰竭、肺栓塞、感染性休克或出血性中风，但发生心肌梗死或房颤的频率较低。COVID-19患者的住院死亡率高于流感患者（89 530例患者中有15 104例[16.9%] vs 45 819例患者中有2640例[5.8%]），相对死亡风险为2.9（95%CI 2.8 - 3.0），年龄标准化死亡率比为2.82。 在住院病人中，（<18岁）的比例小于流感（1227 [1.4%] vs 8942 [19.5%]），但年龄小于5岁的患者中，需要重症监护支持的COVID-19患者比例高于流感患者（613例中的14例[2.3%] vs 6973例中的65例[0.9%]）。在青少年（11-17岁）中，COVID-19的住院死亡率是流感的10倍（458例中的5例[1.1%] vs 804例中的1例[0.1%]），COVID-19患者更常肥胖或超重。需要住院治疗的COVID-19和季节性流感患者的表现差异很大。严重急性呼吸系统综合征冠状病毒2可能具有更高的呼吸道致病性，导致更多的呼吸道并发症和更高的死亡率。在儿童中，尽管COVID-19的住院率似乎低于流感，但住院死亡率较高;然而，患者人数较少限制了这一发现。这些发现强调了对COVID-19采取适当预防措施的重要性，以及对特定疫苗和治疗的需求。法国国家研究机构。
To date, influenza epidemics have been considered suitable for use as a model for the COVID-19 epidemic, given that they are respiratory diseases with similar modes of transmission. However, data directly comparing the two diseases are scarce. We did a nationwide retrospective cohort study using the French national administrative database (PMSI), which includes discharge summaries for all hospital admissions in France. All patients hospitalised for COVID-19 from March 1 to April 30, 2020, and all patients hospitalised for influenza between Dec 1, 2018, and Feb 28, 2019, were included. The diagnosis of COVID-19 (International Classification of Diseases [10th edition] codes U07.10, U07.11, U07.12, U07.14, or U07.15) or influenza (J09, J10, or J11) comprised primary, related, or associated diagnosis. Comparisons of risk factors, clinical characteristics, and outcomes between patients hospitalised for COVID-19 and influenza were done, with data also stratified by age group. 89 530 patients with COVID-19 and 45 819 patients with influenza were hospitalised in France during the respective study periods. The median age of patients was 68 years (IQR 52–82) for COVID-19 and 71 years (34–84) for influenza. Patients with COVID-19 were more frequently obese or overweight, and more frequently had diabetes, hypertension, and dyslipidaemia than patients with influenza, whereas those with influenza more frequently had heart failure, chronic respiratory disease, cirrhosis, and deficiency anaemia. Patients admitted to hospital with COVID-19 more frequently developed acute respiratory failure, pulmonary embolism, septic shock, or haemorrhagic stroke than patients with influenza, but less frequently developed myocardial infarction or atrial fibrillation. In-hospital mortality was higher in patients with COVID-19 than in patients with influenza (15 104 [16·9%] of 89 530 vs 2640 [5·8%] of 45 819), with a relative risk of death of 2·9 (95% CI 2·8–3·0) and an age-standardised mortality ratio of 2·82. Of the patients hospitalised, the proportion of paediatric patients (<18 years) was smaller for COVID-19 than for influenza (1227 [1·4%] vs 8942 [19·5%]), but a larger proportion of patients younger than 5 years needed intensive care support for COVID-19 than for influenza (14 [2·3%] of 613 vs 65 [0·9%] of 6973). In adolescents (11–17 years), the in-hospital mortality was ten-times higher for COVID-19 than for influenza (five [1·1% of 458 vs one [0·1%] of 804), and patients with COVID-19 were more frequently obese or overweight. The presentation of patients with COVID-19 and seasonal influenza requiring hospitalisation differs considerably. Severe acute respiratory syndrome coronavirus 2 is likely to have a higher potential for respiratory pathogenicity, leading to more respiratory complications and to higher mortality. In children, although the rate of hospitalisation for COVID-19 appears to be lower than for influenza, in-hospital mortality is higher; however, low patient numbers limit this finding. These findings highlight the importance of appropriate preventive measures for COVID-19, as well as the need for a specific vaccine and treatment. French National Research Agency.