Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic.
Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic.
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DOI：
10.1161/strokeaha.120.031975
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发表时间：
2021-01
期刊：
影响因子：
8.3
通讯作者：
Sheth KN
中科院分区：
文献类型：
--
作者：
Sharma R;Kuohn LR;Weinberger DM;Warren JL;Sansing LH;Jasne A;Falcone G;Dhand A;Sheth KN
冠状病毒-19（COVID-19）大流行期间过度血管特异性死亡率的幅度和驱动因素尚不清楚。我们的目标是量化过度中风相关死亡，并描述其与社交距离行为和COVID-19相关血管病变的关系。2020年1月至5月美国和州一级的脑血管死亡人数使用国家卫生统计数据中心和泊松回归模型进行量化。使用线性回归分析过量脑血管死亡作为随时间变化的中风相关EMS呼叫和累积COVID-19死亡的函数。进行了州一级的回归分析，以确定在首例COVID-19死亡（2月29日）后的大流行高峰期间，由Google社区移动报告测量的过多脑血管死亡与居住时间之间的关联。包括40个州和纽约市。截至2020年3月28日至5月2日的几周内，全国范围内发生了过度的脑血管死亡率，在4月18日的一周内，比预期水平增加了7.8%。卒中相关EMS呼叫减少与1周后（每减少1000次EMS呼叫，70例死亡，95% CI 20，118）和2周后（每减少1000次EMS呼叫，85例死亡，95% CI 37，133）的过量卒中死亡相关。23个州和纽约市在大流行高峰期经历了过度的脑血管死亡率。在调整COVID-19死亡后，在家花费的时间增加10%与卒中死亡增加4.3%相关（IRR 1.043，95%CI 1.001-1.085）。在COVID-19大流行期间，观察到美国脑血管死亡人数过多，这与全国范围内与中风相关的EMS呼叫减少和州一级的流动性有关。需要采取公共卫生措施，以识别和应对新型冠状病毒大流行期间对急性中风寻求医疗护理的沉默。
The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus-19 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19 related vascular pathology. U.S. and state-level excess cerebrovascular deaths from January-May 2020 were quantified using National Center for Health Statistic data and Poisson regression models. Excess cerebrovascular deaths were analyzed as a function of time-varying stroke-related EMS calls and cumulative COVID-19 deaths using linear regression. A state-level regression analysis was performed to determine the association between excess cerebrovascular deaths and time spent in residences, measured by Google Community Mobility Reports, during the height of the pandemic after the first COVID-19 death (February 29th). Forty states and New York City were included. Excess cerebrovascular mortality occurred nationally from the weeks ending March 28-May 2nd, 2020, up to a 7.8% increase above expected levels during the week of April 18th. Decreased stroke-related EMS calls were associated with excess stroke deaths one (70 deaths per 1000 fewer EMS calls, 95% CI 20, 118) and two weeks (85 deaths per 1000 fewer EMS calls, 95% CI 37, 133) later. Twenty-three states and NYC experienced excess cerebrovascular mortality during the pandemic height. A 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths (IRR 1.043, 95% CI 1.001–1.085) after adjusting for COVID-19 deaths. Excess U.S. cerebrovascular deaths during the COVID-19 pandemic were observed and associated with decreases in stroke-related EMS calls nationally and mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.