Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study.
Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study.
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DOI：
10.1016/s2214-109x(21)00289-8
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
DATCOV author group
中科院分区：
文献类型：
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作者：
Jassat W;Mudara C;Ozougwu L;Tempia S;Blumberg L;Davies MA;Pillay Y;Carter T;Morewane R;Wolmarans M;von Gottberg A;Bhiman JN;Walaza S;Cohen C;DATCOV author group
南非的第一波 COVID-19 疫情于 2020 年 7 月达到高峰，规模更大的第二波疫情于 2021 年 1 月达到高峰，其中 SARS-CoV-2 501Y.V2 (Beta) 谱系占主导地位。我们的目的是比较第一波和第二波之间的院内死亡率和其他患者特征。在这项前瞻性队列研究中，我们分析了 DATCOV 国家主动监测系统中 2020 年 3 月 5 日至 2021 年 3 月 27 日期间入院的 COVID-19 数据。该系统包含来自南非所有收治过 COVID-19 患者的医院的数据。我们使用入院的发病风险和确定的截止日期来定义五个波期：前波 1、波 1、后波 1、波 2 和后波 2。我们比较了在波 1 和波 2 中入院的 COVID-19 患者的特征，以及使用随机效应多变量 Logistic 回归计算波期的院内死亡率的危险因素。第二波中 COVID-19 病例、入院率和院内死亡人数的峰值率超过了第一波的峰值率：COVID-19 病例每 100 万人中有 240·4 例，而每 100 万人中有 136·0 例；入院人数，每100万人中有27·9人入院，而每10万人中有16·1人入院；死亡人数，每 100 000 人有 8·3 人死亡，而每 100 000 人有 3·6 人死亡。入院人数的周平均增长率在第 1 波中为 20%，在第 2 波中为 43%（第 2 波与第 1 波的增长率比率为 1·19，95% CI 1·18–1·20）。与第一波相比，第二波入院的患者年龄更有可能为 40-64 岁（调整后比值比 [aOR] 1·22，95% CI 1·14–1·31），并且与 40 岁以下的患者相比，年龄大于 65 岁（aOR 1·38，1·25–1·52）；与白人相比，混血种族（aOR 1·21、1·06–1·38）的比例；并获准进入公共部门（aOR 1·65、1·41–1·92）；与白人相比，黑人（aOR 0·53、0·47–0·60）和印第安人（aOR 0·77、0·66–0·91）的可能性较小；并且有合并症（aOR 0·60, 0·55–0·67）。对于多变量分析，调整每周 COVID-19 入院人数后，第二波住院死亡率风险增加了 31%（aOR 1·31，95% CI 1·28–1·35）。院内病死风险从低入院率周（<3500 例入院人数）的 17·7% 增加到高入院率周（>8000 例入院人数；aOR 1·24、1·17–1·32）的 26·9%。在南非，第二波疫情与新冠肺炎 (COVID-19) 发病率较高、入院人数增加较快以及住院死亡率增加有关。尽管死亡率增加的部分原因可以解释为第二波入院的患者更有可能是老年人、公共部门以及卫生系统压力增加，但入院患者死亡率的残余增加可能与新的 Beta 谱系有关。 DATCOV 作为国家监测系统，由国家传染病研究所和南非国家政府资助。
The first wave of COVID-19 in South Africa peaked in July, 2020, and a larger second wave peaked in January, 2021, in which the SARS-CoV-2 501Y.V2 (Beta) lineage predominated. We aimed to compare in-hospital mortality and other patient characteristics between the first and second waves. In this prospective cohort study, we analysed data from the DATCOV national active surveillance system for COVID-19 admissions to hospital from March 5, 2020, to March 27, 2021. The system contained data from all hospitals in South Africa that have admitted a patient with COVID-19. We used incidence risk for admission to hospital and determined cutoff dates to define five wave periods: pre-wave 1, wave 1, post-wave 1, wave 2, and post-wave 2. We compared the characteristics of patients with COVID-19 who were admitted to hospital in wave 1 and wave 2, and risk factors for in-hospital mortality accounting for wave period using random-effect multivariable logistic regression. Peak rates of COVID-19 cases, admissions, and in-hospital deaths in the second wave exceeded rates in the first wave: COVID-19 cases, 240·4 cases per 100 000 people vs 136·0 cases per 100 000 people; admissions, 27·9 admissions per 100 000 people vs 16·1 admissions per 100 000 people; deaths, 8·3 deaths per 100 000 people vs 3·6 deaths per 100 000 people. The weekly average growth rate in hospital admissions was 20% in wave 1 and 43% in wave 2 (ratio of growth rate in wave 2 compared with wave 1 was 1·19, 95% CI 1·18–1·20). Compared with the first wave, individuals admitted to hospital in the second wave were more likely to be age 40–64 years (adjusted odds ratio [aOR] 1·22, 95% CI 1·14–1·31), and older than 65 years (aOR 1·38, 1·25–1·52), compared with younger than 40 years; of Mixed race (aOR 1·21, 1·06–1·38) compared with White race; and admitted in the public sector (aOR 1·65, 1·41–1·92); and less likely to be Black (aOR 0·53, 0·47–0·60) and Indian (aOR 0·77, 0·66–0·91), compared with White; and have a comorbid condition (aOR 0·60, 0·55–0·67). For multivariable analysis, after adjusting for weekly COVID-19 hospital admissions, there was a 31% increased risk of in-hospital mortality in the second wave (aOR 1·31, 95% CI 1·28–1·35). In-hospital case-fatality risk increased from 17·7% in weeks of low admission (<3500 admissions) to 26·9% in weeks of very high admission (>8000 admissions; aOR 1·24, 1·17–1·32). In South Africa, the second wave was associated with higher incidence of COVID-19, more rapid increase in admissions to hospital, and increased in-hospital mortality. Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage. DATCOV as a national surveillance system is funded by the National Institute for Communicable Diseases and the South African National Government.