Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative.
Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative.
复制标题
DOI：
10.1371/journal.pone.0279968
复制
发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Hodder, Sally L.
中科院分区：
文献类型：
--
作者：
Anzalone, Alfred Jerrod;Sun, Jing;Vinson, Amanda J.;Beasley, William H.;Hillegass, William B.;Murray, Kimberly;Hendricks, Brian M.;Haendel, Melissa;Geary, Carol Reynolds;Bailey, Kristina L.;Hanson, Corrine K.;Miele, Lucio;Horswell, Ronald;McMurry, Julie A.;Porterfield, J. Zachary;Vest, Michael T.;Bunnell, H. Timothy;Harper, Jeremy R.;Price, Bradley S.;Santangelo, Susan L.;Rosen, Clifford J.;McClay, James C.;Hodder, Sally L.
虽然COVID-19疫苗可以减少不良后果，但接种后的SARS-CoV-2感染仍然存在问题。我们试图根据农村情况确定影响完全接种者突破性感染（BTI）风险的社区因素。我们对2021年1月1日至12月20日期间从国家COVID队列协作（N3C）中抽取的美国成年人进行了回顾性队列研究。利用Kaplan-Meier和Cox-Proportional Hazards模型，对人口统计学差异和合并症进行了调整，我们评估了在2021年1月1日至9月21日期间两次mRNA COVID-19疫苗接种后180天内，乡村性、县疫苗犹豫和县疫苗接种率对BTI风险的影响。此外，Cox比例风险模型评估了未接种疫苗的成年人的感染风险。在研究期间，我们使用多变量logistic回归评估了基于疫苗接种状况的住院和不良COVID-19事件的几率。我们的研究人群包括566,128名接种疫苗的成年人和1,724,546名没有接种疫苗的成年人。在接种疫苗的人群中，与城市居民相比，农村居民患BTI的风险增加（调整后的风险比[aHR] 1.53, 95%可信区间[CI] 1.42-1.64，与城市相邻的农村居民为1.65，与非城市相邻的农村居民为1.42-1.91）。与低疫苗犹豫县相比，中等（1.07,1.02-1.12）和高（1.33,1.23-1.43）疫苗犹豫县的BTI风险较高。与高接种率县相比，居住在低接种率县（1.34,1.27-1.43）而非中等接种率县（1.00,0.95-1.07）的人群患BTI的风险较高。社区因素也与未接种疫苗的人感染SARS-CoV-2的几率较高有关。在研究期间，接种过SARS-CoV-2疫苗的感染者在所有地理区域和社区暴露中住院和不良事件的几率显著降低。我们的研究结果表明，社区因素与BTI风险增加有关，特别是在疫苗犹豫度高的农村地区和县。在疫苗接种保护减弱的情况下，社区，如农村和疫苗接种犹豫地区的社区，以及发生不良突破事件高风险的某些群体，包括免疫抑制/受损人群，应继续得到公共卫生关注、有针对性的干预措施和一致的指导，以帮助管理社区传播。
While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. We conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier and Cox-Proportional Hazards models adjusted for demographic differences and comorbid conditions, we assessed impact of rurality, county vaccine hesitancy, and county vaccination rates on risk of BTI over 180 days following two mRNA COVID-19 vaccinations between January 1 and September 21, 2021. Additionally, Cox Proportional Hazards models assessed the risk of infection among adults without documented vaccinations. We secondarily assessed the odds of hospitalization and adverse COVID-19 events based on vaccination status using multivariable logistic regression during the study period. Our study population included 566,128 vaccinated and 1,724,546 adults without documented vaccination. Among vaccinated persons, rurality was associated with an increased risk of BTI (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42–1.64, for urban-adjacent rural and 1.65, 1.42–1.91, for nonurban-adjacent rural) compared to urban dwellers. Compared to low vaccine-hesitant counties, higher risks of BTI were associated with medium (1.07, 1.02–1.12) and high (1.33, 1.23–1.43) vaccine-hesitant counties. Compared to counties with high vaccination rates, a higher risk of BTI was associated with dwelling in counties with low vaccination rates (1.34, 1.27–1.43) but not medium vaccination rates (1.00, 0.95–1.07). Community factors were also associated with higher odds of SARS-CoV-2 infection among persons without a documented vaccination. Vaccinated persons with SARS-CoV-2 infection during the study period had significantly lower odds of hospitalization and adverse events across all geographic areas and community exposures. Our findings suggest that community factors are associated with an increased risk of BTI, particularly in rural areas and counties with high vaccine hesitancy. Communities, such as those in rural and disproportionately vaccine hesitant areas, and certain groups at high risk for adverse breakthrough events, including immunosuppressed/compromised persons, should continue to receive public health focus, targeted interventions, and consistent guidance to help manage community spread as vaccination protection wanes.
登录
查看更多内容
DOI：
10.1016/s1473-3099(21)00674-5
发表时间：
2022-03
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Desai D;Khan AR;Soneja M;Mittal A;Naik S;Kodan P;Mandal A;Maher GT;Kumar R;Agarwal A;Gowda NR;H V;Kumar P;Pandey S;Pandey RM;Kumar A;Ray A;Jorwal P;Nischal N;Choudhary A;Brijwal M;Madan K;Lodha R;Sinha S;Dar L;Wig N;Guleria R
通讯作者：
Guleria R
DOI：
10.1016/s1473-3099(21)00330-3
发表时间：
2021-11
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Hyams C;Marlow R;Maseko Z;King J;Ward L;Fox K;Heath R;Tuner A;Friedrich Z;Morrison L;Ruffino G;Antico R;Adegbite D;Szasz-Benczur Z;Garcia Gonzalez M;Oliver J;Danon L;Finn A
通讯作者：
Finn A
DOI：
10.1093/jamia/ocaa196
发表时间：
2021-03-01
影响因子：
6.4
作者：
Haendel, Melissa A.;Chute, Christopher G.;Gersing, Ken R.
通讯作者：
Gersing, Ken R.
影响因子：
4.5
作者：
Freed GL
通讯作者：
Freed GL
影响因子：
3.7
作者：
Kennedy, Jonathan
通讯作者：
Kennedy, Jonathan